Retrograde approach for complex popliteal and tibioperoneal occlusions.
OBJECTIVE
To describe the technical aspects of the retrograde approach for endovascular treatment of complex popliteal and/or tibioperoneal occlusions and determine its efficacy in minimizing failure rates.


METHODS
An observational registry of retrograde revascularizations was maintained at our institution over 14 months (September 2006 to December 2007). During this time frame, antegrade revascularization failed in 62 (17.8%) of 343 limbs with complex total occlusions of the popliteal and/or infrapopliteal vascular territory. Of these antegrade failures, 51 (82.2%) limbs in 51 patients (32 men; mean age 72+/-8 years) were suitable for a retrograde attempt. From this subgroup, 45 (88.2%) were treated via a percutaneous transpedal access site and 6 (11.8%) via a transcollateral intra-arterial technique.


RESULTS
The overall success rate was 86.3% (44/51); adjunctive stenting was needed in 21 (41.1%) to optimize results. Only 1 (1.9%) major complication (a pedal access site occlusion) and 4 (7.8%) minor sequelae (arterial perforation in 3 and a pedal hematoma without consequence) were documented.


CONCLUSIONS
In complex popliteal to infrapopliteal occlusions, an antegrade recanalization attempt can fail in up to 20% of the cases. The additional use of a retrograde approach seems feasible and safe and can favorably modify this failure rate. This technique could be valuable for patients with critical limb ischemia due to popliteal and infrapopliteal occlusions once larger studies with follow-up confirm safety, efficacy, and clinical benefit.
Department of Medicine I, Angiology/Cardiology, Park Hospital, University of Leipzig Heart Center, Leipzig, Germany.
Miguel
M
Montero-Baker
Andrej
A
Schmidt
Sven
S
Bräunlich
Matthias
M
Ulrich
Marcus
M
Thieme
Giancarlo
G
Biamino
Spiridon
S
Botsios
Yvonne
Y
Bausback
Dierk
D
Scheinert
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011150:Popliteal Artery; D016909:Tibial Arteries; D014656:Vascular Surgical Procedures / Q000379:methods