title: Retrograde Transpedal Access for Revascularization of Below-the-Knee Arteries in Patients with Critical Limb Ischemia after an Unsuccessful Antegrade Transfemoral Approach.
abstract: OBJECTIVE
  To evaluate the safety and technical and clinical success of endovascular below-the-knee (BTK) artery revascularization by a retrograde transpedal access.
  
  
  METHODS
  We retrospectively identified 16/172 patients (9.3 %) with endovascular BTK revascularization in whom a transfemoral approach had failed and transpedal access had been attempted. The dorsal pedal (n = 13) or posterior tibial (n = 3) artery was accessed using a dedicated access set and ultrasound guidance. The procedure was finished in antegrade fashion by plain old balloon angioplasty (POBA). Comorbidities, vessel diameter and calcification at the access site were recorded. The analyzed outcomes were technical success, procedural complications, procedure time, crossing (guidewire beyond lesion and intra-luminal) and procedural (residual stenosis < 30 % after POBA) success, and limb salvage.
  
  
  RESULTS
  Diabetes, coronary artery disease and hypertension were present in 15 patients (93.8 %), and both renal impairment and previous amputations in 7 (43.8 %). Pedal access vessel calcification was present in 5/16 patients (31.3 %). The mean diameter was 1.75 +/-0.24 mm. The procedure time was 92.4 +/-23 min. The success rate for achieving retrograde access was 100 %. Retrograde crossing was successful in 12/16 patients (75.0 %). Procedural success was observed in 10/16 patients (68.8 %). Minor complications occurred in 2/16 patients (12.5 %). The rate of limb salvage was 72.9 %, and the overall survival was 100 % at 12 months. Major amputations after revascularization occurred in 2/16 patients (12.5 %).
  
  
  CONCLUSIONS
  If an antegrade transfemoral approach to BTK lesions fails, a retrograde transpedal approach may nevertheless facilitate treatment. This approach appears to be safe and offers high technical and acceptable clinical success rates.
  
  
  CONCLUSIONS
  • Retrograde approaches via transpedal or transtibial vessels are safe and offer high technical success.• One problem after technically successful puncture might be the re-entry following subintimal retrograde lesion crossing.• After a failed attempt at antegrade revascularization of a BTK occlusion, a retrograde approach should be performed. Citation Format: • Goltz JP, Planert M, Horn M et al. Retrograde Transpedal Access for Revascularization of Below-the-Knee Arteries in Patients with Critical Limb Ischemia after an Unsuccessful Antegrade Transfemoral Approach. Fortschr Röntgenstr 2016; 188: 940 - 948.
authors.affiliation: Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: J P
authors.initials: JP
authors.lastname: Goltz
authors.affiliation: Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Planert
authors.affiliation: Department for Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Horn
authors.affiliation: Department for Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wiedner
authors.affiliation: Department for Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kleemann
authors.affiliation: Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Barkhausen
authors.affiliation: Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Stahlberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery*; D007717:Knee / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000379:methods*