title: Tibiopedal Access for Crossing of Infrainguinal Artery Occlusions: A Prospective Multicenter Observational Study.
abstract: To report a prospective, multicenter, observational study (ClinicalTrials.gov identifier NCT01609621) of the safety and effectiveness of tibiopedal access and retrograde crossing in the treatment of infrainguinal chronic total occlusions (CTOs).
  
  
  
  Twelve sites around the world prospectively enrolled 197 patients (mean age 71±11 years, range 41-93; 129 men) from May 2012 to July 2013 who met the inclusion criterion of at least one CTO for which a retrograde crossing procedure was planned or became necessary. The population consisted of 64 (32.5%) claudicants (Rutherford categories 2/3) and 133 (67.5%) patients with critical limb ischemia (Rutherford category ≥4). A primary antegrade attempt to cross had been made prior to the tibiopedal attempt in 132 (67.0%) cases. Techniques used for access, retrograde lesion crossing, and treatment were at the operator's discretion. Follow-up data were obtained 30 days after the procedure.
  
  
  
  Technical tibiopedal access success was achieved in 184 (93.4%) of 197 patients and technical occlusion crossing success in 157 (85.3%) of the 184 successful tibial accesses. Failed access attempts were more common in women (9 of 13 failures). The rate of successful crossing was roughly equivalent between sexes [84.7% (50/59) women compared to 85.6% (107/125) men]. Technical success did not differ significantly based on a prior failed antegrade attempt: the access success rate was 92.4% (122/132) after a failed antegrade access vs 95.4% (62/65) in those with a primary tibiopedal attempt (p=0.55). Similarly, crossing success was achieved in 82.8% (101/122) after a failed antegrade access vs 90.3% (56/62) for patients with no prior antegrade attempt (p=0.19). Minor complications related to the access site occurred in 11 (5.6%) cases; no patient had access vessel thrombosis, compartment syndrome, or surgical revascularization.
  
  
  
  Tibiopedal access appears to be safe and can be used effectively for the crossing of infrainguinal lesions in patients with severe lower limb ischemia.
authors: Cardiovascular Institute of the South, Houma, LA, USA drcrwalker@gmail.com.
authors: Craig M
authors: CM
authors: Walker
authors: Metro Health Hospital, Wyoming, MI, USA.
authors: Jihad
authors: J
authors: Mustapha
authors: Universitaets-Herzzentrum Freiberg, Bad Krozingen, Germany.
authors: Thomas
authors: T
authors: Zeller
authors: Department for Interventional Angiology, University Hospital Leipzig, Germany.
authors: Andrej
authors: A
authors: Schmidt
authors: Tucson Medical Center, Tucson, AZ, USA.
authors: Miguel
authors: M
authors: Montero-Baker
authors: CAMC Health Education and Research Institute, Inc, West Virginia University, Charleston, WV, USA.
authors: Aravinda
authors: A
authors: Nanjundappa
authors: Casa Di Cura Abano Terme, Italy.
authors: Marco
authors: M
authors: Manzi
authors: Casa Di Cura Abano Terme, Italy.
authors: Luis Mariano
authors: LM
authors: Palena
authors: MedStar Health Research Institute, Washington Hospital Center, Washington, DC, USA.
authors: Nelson
authors: N
authors: Bernardo
authors: First Coast Cardiovascular Institute, Jacksonville, FL, USA.
authors: Yazan
authors: Y
authors: Khatib
authors: Mount Sinai Medical Center, Miami Beach, FL, USA.
authors: Robert
authors: R
authors: Beasley
authors: Tucson Medical Center, Tucson, AZ, USA.
authors: Luis
authors: L
authors: Leon
authors: Metro Health Hospital, Wyoming, MI, USA.
authors: Fadi A
authors: FA
authors: Saab
authors: MED Institute, Inc, West Lafayette, IN, USA.
authors: Adam R
authors: AR
authors: Shields
authors: University of North Carolina, Rex Hospital, Raleigh, NC, USA.
authors: George L
authors: GL
authors: Adams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: chronic total occlusion; critical limb ischemia; peripheral artery disease; retrograde approach; tibiopedal; transpedal; vascular access