title: Dual vascular access for critical limb ischemia: immediate and follow-up results.
abstract: OBJECTIVE
  To describe a procedural technique involving a combined antegrade femoral and retrograde tibial approach for treatment of complex popliteal and infrapopliteal occlusions, and to determine the safety and efficacy of this technique.
  
  
  METHODS
  From May 2008 to March 2010, seven patients presenting with critical limb ischemia received dual vascular access intervention in this institution. Five legs were treated via the retrograde tibial approach after failure of antegrade intervention. A dual access approach was planned and adopted in another two legs. The target vessels were located at popliteal or infrapopliteal arteries.
  
  
  RESULTS
  We successfully gained all retrograde tibial access sites and achieved 100% procedural success and immediate hemodynamic improvement. Five legs required stent implantation to optimize the procedural results. No major complication occurred at the tibial access site. During the follow-up period (11.3 ± 7.2, range 3-23 months), no patients required any major amputation; only one patient underwent a mid-foot amputation. The target vessel revascularization rate at 3 and 6 months was 0 and 28.6%, respectively.
  
  
  CONCLUSIONS
  Dual vascular access was successfully used in a small number of selected patients and this technique may hold promise in improving the success rates in the treatment of complex popliteal and infrapopliteal occlusions.
authors.affiliation: Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taiwan.
authors.forename: Kuan-Hung
authors.initials: KH
authors.lastname: Yeh
authors.forename: Yueh-Ju
authors.initials: YJ
authors.lastname: Tsai
authors.forename: Hsuan-Li
authors.initials: HL
authors.lastname: Huang
authors.forename: Hsin-Hua
authors.initials: HH
authors.lastname: Chou
authors.forename: Hern-Jia
authors.initials: HJ
authors.lastname: Chang
authors.forename: Yu-Lin
authors.initials: YL
authors.lastname: Ko
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000295:instrumentation; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000379:methods*; D003251:Constriction, Pathologic; D016638:Critical Illness; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D015607:Stents; D013624:Taiwan; D016909:Tibial Arteries / Q000000981:diagnostic imaging; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex