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.

Comments:

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.


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(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