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Monday, December 1, 2014

Pedal Access for Revascularization of Infrainguinal Occlusive Disease

While treatment of endovascular revascularization in CLI is an effective method to achieve limb salvage, technical success and amputation-free survival vary widely. However, in a patient that fails antegrade recanalization in whom bypass options are nonextistent, a retrograde approach from a pedal access may be a viable option. Researchers from the University of Virginia presented their experience with pedal access in 99 limbs. Technical success was achieved in 89% of patients with a majority involving subinitimal recanalization. The limb salvage rate for technically successful cases was 74% at 6 months, 64% at 12 months, and 55% at 24 months.

This study is one of the largest series of pedal access cases and shows a high technical success rate in a challenging patient population. While limb salvage rates are not ideal, the study was limited by premature amputations and revascularization to achieve tissue healing for a pre-planned amputation.

Click here to see the full abstract

(a) Digital subtraction angiography shows occlusion of the distal popliteal artery (black arrow) and reconstitution of the anterior tibial artery (white arrow). (b) Retrograde access is obtained using a micropuncture needle (arrow). (c) A through-and-through flossing guide wire is established by advancing the retrograde wire (white arrow) through the end hole of the antegrade catheter (black arrow) via a retrograde 3-F catheter (arrowheads) as a support catheter. (d) Completion angiogram after angioplasty shows in-line patency of and to the anterior tibial artery (arrows).

Citation: Sabri, S. S. et al. Retrograde Pedal Access Technique for Revascularization of Infrainguinal Arterial Occlusive Disease. Journal of Vascular and Interventional Radiology (2014). doi:doi: 10.1016/j.jvir.2014.10.008

Post Author: Luke Wilkins, MD

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