title: Utility and feasibility of ultrasound-guided access in patients with critical limb ischemia.
abstract: BACKGROUND
  Patients with advanced peripheral vascular disease (PVD) and critical limb ischemia (CLI) require immediate revascularization to improve blood flow and prevent amputation. Vascular, and especially tibial, access is arguably a very important part of the procedure. Utilization of ultrasound (US) guidance to access the peripheral vessels will maximize success and decrease the risk of complications.
  
  
  METHODS
  This is a retrospective analysis of patients admitted to our institution between 2010 and 2011. Eighty-six patients with 191 lesions underwent revascularization for advanced PVD and CLI. US guidance was utilized to access the vascular bed in an antegrade or retrograde fashion in 100% of these patients. Data collected included success rate and time to access using US. Immediate in hospital and 30 day outcomes were also documented.
  
  
  RESULTS
  The average age of patients was 69.8 years, with 69.7% male patients. All tibial access (33.7%) was obtained under US guidance. Obtaining vascular access using US was achieved in 95.3% of patients. At discharge, access site complications were limited to one patient (1.1%) with a pseudoaneurysm; no access complications related to the tibial vessels. At 30 days, there was one major amputation (1.1%) and one vascular access complication (1.1%).
  
  
  CONCLUSIONS
  US guided access is a feasible and safe procedure that can aid in accessing vascular conduits in patients with CLI. Applying this technique across the board in CLI patients decreases the risk of immediate complications and facilitates accessing tibial arteries.
authors.affiliation: Department of Internal Medicine, Metro Heart and Vascular, Michigan State University, School of Medicine, Metro Health Hospital, Wyoming, Michigan, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Mustapha
authors.forename: Fadi
authors.initials: F
authors.lastname: Saab
authors.forename: Larry
authors.initials: L
authors.lastname: Diaz
authors.forename: Barbara
authors.initials: B
authors.lastname: Karenko
authors.forename: Lance
authors.initials: L
authors.lastname: Richards
authors.forename: Theresa
authors.initials: T
authors.lastname: Laeder
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Heaney
authors.forename: Tony
authors.initials: T
authors.lastname: Das
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D057510:Endovascular Procedures; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012039:Regional Blood Flow; D012189:Retrospective Studies; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional