title: Vascular access in critical limb ischemia.
abstract: Currently, percutaneous endovascular intervention is considered a first line of therapy for treating patients with critical limb ischemia. As the result of remarkable development of techniques and technologies, percutaneous endovascular intervention has led to rates of limb salvage comparable to those achieved with bypass surgery, with fewer complications, even in the presence of lower rates of long-term patency. Currently, interventionalists have a multiplicity of access routes including smaller arteries, with both antegrade and retrograde approaches. Therefore, the choice of the optimal access site has become an integral part of the success of the percutaneous intervention. By understanding the technical aspects, as well as the advantages and limitations of each approach, the interventionalists can improve clinical outcomes in patients with severe peripheral arterial disease. This article reviews the access routes in critical limb ischemia, their advantages and disadvantages, and the clinical outcomes of each.
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Won Yu
authors.initials: WY
authors.lastname: Kang
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Umberto
authors.initials: U
authors.lastname: Campia
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ota
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Romain J
authors.initials: RJ
authors.lastname: Didier
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Smita I
authors.initials: SI
authors.lastname: Negi
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Sarkis
authors.initials: S
authors.lastname: Kiramijyan
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Nevin C
authors.initials: NC
authors.lastname: Baker
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhaes
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escarcega
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States. Electronic address: Nelson.L.Bernardo@Medstar.net.
authors.forename: Nelson L
authors.initials: NL
authors.lastname: Bernardo
mesh_terms: D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D016638:Critical Illness; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011677:Punctures; D015641:Radiography, Interventional; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Amputation; Antegrade access; Critical limb ischemia; Limb salvage; Metatarsal; Pedal; Retrograde access; Vascular access