title: Long-Term Outcomes of Successful Endovascular Therapy Via the Retrograde Approach for Below-the-Knee Chronic Total Occlusion in Patients With Critical Limb Ischemia After a Failed Antegrade Approach.
abstract: OBJECTIVE
  This study evaluated long-term results following successful endovascular therapy (EVT) for chronic total occlusion (CTO) below the knee (BTK) using the retrograde approach after a failed antegrade approach.
  
  
  METHODS
  Nineteen patients (19 limbs) with critical limb ischemia (CLI) who underwent successful EVT for BTK-CTO using the retrograde approach after a failed antegrade approach during 2010-2014 were studied.
  
  
  RESULTS
  Mean duration of the follow-up period was 25.5 ± 17.9 months, and mean age was 76.0 ± 8.6 years. Patients on hemodialysis accounted for 10 cases (52.6%). Patients with Rutherford class 4 constituted 3 cases (15.8%) , while 8 patients each (42.1%) were categorized as Rutherford class 5 and class 6, respectively. All lesions were de novo CTOs. The mean occlusion length was 203.7 ± 114.7 mm. Vascular access for the retrograde approach was obtained via distal puncture in 9 cases (47.4%), whereas the transcollateral approach was employed in 10 cases (52.6%). The amputation-free survival rates at 1, 2, 3, 4, and 5 years after the index procedure were 78.6%, 66.9%, 66.9%, 50.2%, and 50.2%, respectively.
  
  
  CONCLUSIONS
  Successful EVT for BTK-CTO using various techniques via the retrograde approach provides promising long-term results in patients with CLI.
authors.affiliation: Department of Cardiology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247- 0072, Japan. mjunya2318@gmail.com.
authors.forename: Junya
authors.initials: J
authors.lastname: Matsumi
authors.forename: Takuma
authors.initials: T
authors.lastname: Takada
authors.forename: Noriaki
authors.initials: N
authors.lastname: Moriyama
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ochiai
authors.forename: Kazuki
authors.initials: K
authors.lastname: Tobita
authors.forename: Koki
authors.initials: K
authors.lastname: Shishido
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sugitatsu
authors.forename: Shingo
authors.initials: S
authors.lastname: Mizuno
authors.forename: Futoshi
authors.initials: F
authors.lastname: Yamanaka
authors.forename: Masato
authors.initials: M
authors.lastname: Murakami
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Saeko
authors.initials: S
authors.lastname: Takahashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Akasaka
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
mesh_terms: D000368:Aged; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D017211:Treatment Failure