title: Retrograde pedal access technique for revascularization of infrainguinal arterial occlusive disease.
abstract: OBJECTIVE
  To evaluate limb salvage after recanalization of lower extremity arteries using retrograde pedal access in patients with critical limb ischemia (CLI).
  
  
  METHODS
  A retrospective review was performed of all patients in whom retrograde pedal arterial access was used for recanalization of infrainguinal occlusive disease between September 2002 and January 2013. Treatment was performed in 99 limbs in 92 patients (64 men and 28 women; median age, 71.6 y; range, 44-91 y) with CLI and no appropriate venous conduit for surgical bypass. Treated limbs were classified as Rutherford class 5 or 6 in 88% and class 4 in 12%. Retrograde and antegrade accesses were combined when occlusions could not be crossed from the antegrade direction. The treated occlusive segments were limited to the femoropopliteal arteries in 22% of procedures, runoff arteries in 32%, or both segments in 46%. Technical success was defined as successful crossing of the lesion and achievement of inline flow to the pedal vessel. Kaplan-Meier analysis was performed to determine limb salvage rate.
  
  
  RESULTS
  Technical success was achieved in 88 of 99 (89%) treated limbs. Stents were placed for suboptimal angioplasty results in 41 of 88 (47%) successfully treated limbs. Major complications occurred in 8 of 99 (8%) procedures, 3 of which resulted in periprocedural mortality. Median follow-up was 8 months (mean, 17 mo; range, 1-98 mo). The limb salvage rate for technically successful cases was 74% at 6 months, 64% at 12 months, and 55% at 24 months.
  
  
  CONCLUSIONS
  Retrograde pedal access is a viable revascularization technique for achieving limb salvage in patients with CLI.
authors.affiliation: Department of Radiology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908. Electronic address: ss2bp@virginia.edu.
authors.forename: Saher S
authors.initials: SS
authors.lastname: Sabri
authors.affiliation: Department of Radiology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hendricks
authors.affiliation: Department of Radiology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908.
authors.forename: James
authors.initials: J
authors.lastname: Stone
authors.affiliation: Department of Vascular Surgery, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908.
authors.forename: Megan C
authors.initials: MC
authors.lastname: Tracci
authors.affiliation: Department of Radiology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Matsumoto
authors.affiliation: Department of Radiology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908.
authors.forename: John F
authors.initials: JF
authors.lastname: Angle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D062666:Vascular Access Devices