title: Antegrade vs Crossover Femoral Artery Access in the Endovascular Treatment of Isolated Below-the-Knee Lesions in Patients With Critical Limb Ischemia.
abstract: To evaluate the safety and effectiveness of antegrade vs crossover femoral artery access in the endovascular treatment of isolated below-the-knee (BTK) lesions in patients with critical limb ischemia (CLI).
  
  
  
  Between January 2014 and December 2015, 224 high-risk patients (mean age 75.8±9.8 years; 151 men) with CLI underwent infragenicular interventions on 292 crural vessels in 3 European vascular centers. All patients had isolated TransAtlantic Inter-Society Consensus (TASC) C (n=26) or D (n=198) BTK lesions. Primary endpoints were freedom from access-related complications and technical success comparing the antegrade vs crossover access groups.
  
  
  
  Balloon angioplasty was the most used treatment modality (169 vessels, 75.4%). The technical success rate was 88.4% in the entire cohort and 88.0% in the antegrade group vs 90.4% in the crossover group (p>0.99). In all patients, the technical success rate was higher for stenotic lesions (100%) vs occlusions (85.5%, p=0.002) and in patients with TASC C BTK lesions (100%) vs TASC D (86.9%, p=0.033). The overall freedom from access-related complications was 97.8%: 99% in the antegrade group and 90.6% in the crossover group (p=0.022). Larger sheath size (5/6-F vs 4-F) was associated with a significantly higher risk for access-related complications (7.1% vs 1.1%, respectively; p=0.047).
  
  
  
  The present multicenter study showed high technical success and a low incidence of access-related complications in the treatment of isolated BTK lesions using either antegrade or crossover femoral access. The antegrade approach with the use of a 4-F system seems to have a significantly lower rate of access-related complications.
authors.affiliation: 1 Department of Vascular Surgery, St Franziskus Hospital Münster, Germany.|2 Clinic of Vascular and Endovascular Surgery, University of Münster, Germany.
authors.forename: Yukun
authors.initials: Y
authors.lastname: Li
authors.affiliation: 3 Department of Vascular Surgery, Sana Klinikum Hameln, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Esmail
authors.affiliation: 1 Department of Vascular Surgery, St Franziskus Hospital Münster, Germany.|2 Clinic of Vascular and Endovascular Surgery, University of Münster, Germany.
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Donas
authors.affiliation: 1 Department of Vascular Surgery, St Franziskus Hospital Münster, Germany.|2 Clinic of Vascular and Endovascular Surgery, University of Münster, Germany.|4 Division of Vascular Surgery, Aristotle University of Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Pitoulias
authors.affiliation: 1 Department of Vascular Surgery, St Franziskus Hospital Münster, Germany.|2 Clinic of Vascular and Endovascular Surgery, University of Münster, Germany.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
authors.affiliation: 1 Department of Vascular Surgery, St Franziskus Hospital Münster, Germany.|2 Clinic of Vascular and Endovascular Surgery, University of Münster, Germany.
authors.forename: Theodosios
authors.initials: T
authors.lastname: Bisdas
authors.affiliation: 5 Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Michelagnoli
authors.affiliation: 5 Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Troisi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016638:Critical Illness; D018572:Disease-Free Survival; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005858:Germany; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D007558:Italy; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011677:Punctures; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: antegrade access; anterior tibial artery; balloon angioplasty; below-the-knee lesions; contralateral access; critical limb ischemia; fibular artery; infragenicular vessels; occlusion; popliteal artery; posterior tibial artery; sheath size; stenosis; vascular access