title: Combined retrograde-antegrade arterial wiring: Peroneal artery can be a bridge to cross infrapopliteal Trans Atlantic Inter Society Consensus D lesions.
abstract: BACKGROUND
  Percutaneous transluminal angioplasty of complex infrapopliteal lesions might be a true and complex challenge. Success rates remain suboptimal when employing standard approaches. Thus, recanalization techniques for infrapopliteal disease remain a seat of continuous evolution.
  
  
  OBJECTIVE
  We report our results of Trans Atlantic Inter Society Consensus D infrapopliteal disease recanalization using combined antegrade-retrograde approach through peroneal artery branches.
  
  
  METHODS
  A total of 27 patients with infrapopliteal Trans Atlantic Inter Society Consensus D lesions underwent recanalization of at least one of the tibial arteries by combined retrograde-antegrade route using the peroneal artery normal anastomosis channels.
  
  
  RESULTS
  Technical success was achieved in 22 patients who were followed for 6-24 months. Healing of ischemic ulcers or spontaneous separation of ischemic gangrenous patches in 13 patients. Minor amputation in nine patients. No major amputation in the follow-up period.
  
  
  CONCLUSIONS
  Although demanding, the technique can be reserved for selected cases with failed antegrade recanalization. This technique is valuable when a proximal occlusion is not crossable, when a dissection flap or a perforation in the proximal portion of a target vessel hinders guide-wire advancement. This technique may represent a feasible endovascular option to avoid second distal puncture exhausting the landing zone of a future distal bypass.
authors.affiliation: Department of Vascular Surgery, Faculty of Medicine - Cairo University, Cairo, Egypt usamalotfi@yahoo.com.
authors.forename: Usama
authors.initials: U
authors.lastname: Lotfi
authors.affiliation: Department of Vascular Surgery, Faculty of Medicine - Cairo University, Cairo, Egypt.
authors.forename: Magdy
authors.initials: M
authors.lastname: Haggag
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D012307:Risk Factors; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014945:Wound Healing
keywords: Retrograde antegrade revascularization; infrapoploiteal disease; peroneal artery