title: Retrograde transplantar arch angioplasty of below-the-knee arterial occlusions: outcomes compared to anterograde recanalization.
abstract: OBJECTIVE
  To compare the clinical outcomes of retrograde transplantar arch angioplasty and conventional below-the-knee (BTK) anterograde recanalization.
  
  
  METHODS
  One hundred twelve limbs in 96 patients underwent attempt at antegrade tibial angioplasty. Among 27 technical failures, retrograde trans-dorsal or -planter percutaneous transluminal angioplasty was attempted in 22 limbs. Ankle-brachial index (ABI), thrombolysis in myocardial infarction (TIMI) flow grade, and dorsal/plantar arterial pulse score improvement were compared immediately after the procedures between patients received successful anterograde angioplasty (anterograde angioplasty group [AAG], 85 limbs in 71 patients) and retrograde angioplasty (retrograde angioplasty group [RAG], 22 limbs in 20 patients). Target vessel restenosis and limb salvage were observed during follow-up.
  
  
  RESULTS
  Primary technical success rate was 75.9% in the RAG (vs. 74.0% AAG, P > .05). ABI improved from 0.55 ± 0.21 to 0.93 ± 0.19 in the RAG (vs. 0.56 ± 0.14 to 0.89 ± 0.18 AAG, P > .05). TIMI flow grade demonstrated greater reperfusion of distal foot tissue in the RAG (2.3 ± 0.8 vs. 1.0 ± 0.8, P < .05). Primary patency rates at 12 and 24 months were 63.6% (14 of 22) and 45.5% (10 of 22) in the RAG and 52.9% (45 of 85) and 37.6% (32 of 85) in the AAG, respectively (P > .05). Kaplan-Meier analysis after 24 months found limb salvage rates of 93.8% in the RAG and 96.5% in the AAG (P > .05).
  
  
  CONCLUSIONS
  Retrograde transplantar arch angioplasty achieved better immediate blood flow and similar ABI improvement, primary patency rate, and limb salvage rate compared to conventional transtibial angioplasty for BTK occlusions. This could become a supplementary technique when anterograde angioplasty fails.
authors.affiliation: Departments of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Rd, Shanghai, 200233, China.
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Wei
authors.affiliation: Departments of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Rd, Shanghai, 200233, China. Electronic address: zyq1111@126.com.
authors.forename: Yue-Qi
authors.initials: YQ
authors.lastname: Zhu
authors.affiliation: Departments of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Rd, Shanghai, 200233, China. Electronic address: zhaojungongradio@hotmail.com.
authors.forename: Jun-Gong
authors.initials: JG
authors.lastname: Zhao
authors.affiliation: Departments of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Rd, Shanghai, 200233, China.
authors.forename: Jue
authors.initials: J
authors.lastname: Wang
authors.affiliation: Departments of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Rd, Shanghai, 200233, China.
authors.forename: Hai-Tao
authors.initials: HT
authors.lastname: Lu
authors.affiliation: Departments of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Rd, Shanghai, 200233, China.
authors.forename: Pei-Lei
authors.initials: PL
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D007717:Knee / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Below the knee; angioplasty; plantar arch