title: Endovascular retrograde recanalization in Asian critical limb ischaemia patients.
abstract: BACKGROUND
  To evaluate endovascular retrograde recanalization of critical limb ischaemia (CLI) patients with chronic total occlusions (CTOs) in an Asian population.
  
  
  METHODS
  We conducted a single centre-based retrospective review of CLI patients with CTOs who had undergone endovascular retrograde recanalization using the subintimal arterial flossing with antegrade-retrograde intervention technique.
  
  
  RESULTS
  A total of 40 CLI patients with CTOs underwent endovascular intervention. The median age was 71 years; 67.5% were males and Chinese accounted for 65% of the patients, of which 55% were in Rutherford category 6, 37.5% in category 5 and 7.5% in category 4. Antegrade-retrograde access was performed via the femoral artery in 39 cases and the brachial artery in one case for the proximal puncture, and the following arteries for the distal puncture: superficial femoral, n = 4 (10%); popliteal, n = 4 (10%); anterior tibial, n = 12 (30%); dorsalis pedis, n = 9 (22.5%); peroneal, n = 4 (10%) and posterior tibial, n = 7 (17.5%). Technical success was high at 92.5% (n = 37). After intervention, 25% (n = 10) had below-knee triple vessel runoff, 52.5% (n = 21) had double vessel runoff and 15.0% (n = 6) had single vessel runoff. Stenting for target vessel dissections was required in 12 patients. There were two cases of significant bleeding; one common femoral artery pseudoaneurysm was treated with ultrasound-guided thrombin injection and another case of distal puncture site bleeding only required compression. Limb salvage at 1 year was 92.5% (n = 37).
  
  
  CONCLUSIONS
  The subintimal arterial flossing with antegrade-retrograde intervention technique is safe with high technical success rates and acceptable outcomes in Asian CLI patients with CTOs.
authors.affiliation: Department of General Surgery, Changi General Hospital, Singapore, Singapore.
authors.forename: Jia Sheng
authors.initials: JS
authors.lastname: Tay
authors.affiliation: Department of General Surgery, Changi General Hospital, Singapore, Singapore.
authors.forename: Siok Siong
authors.initials: SS
authors.lastname: Ching
authors.affiliation: Department of General Surgery, Changi General Hospital, Singapore, Singapore.
authors.forename: Yih Kai
authors.initials: YK
authors.lastname: Tan
authors.affiliation: Department of General Surgery, Changi General Hospital, Singapore, Singapore.
authors.forename: Steven Wei Cheong
authors.initials: SWC
authors.lastname: Kum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D044466:Asian People / Q000208:ethnology*; D057510:Endovascular Procedures / Q000379:methods*; D005121:Extremities / Q000098:blood supply* / Q000473:pathology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications / Q000473:pathology; D011677:Punctures / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015607:Stents / Q000706:statistics & numerical data; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000295:instrumentation
keywords: 
  SAFARI
  ; critical limb ischaemia; endovascular; retrograde recanalization