Author + information
- Received February 14, 2019
- Revision received May 8, 2019
- Accepted June 4, 2019
- Published online September 2, 2019.
- Andrej Schmidt, MDa,∗ (, )@SabineSteiner16,
- Yvonne Bausback, MDa,
- Michael Piorkowski, MDb,
- Tim Wittig, MDa,
- Ursula Banning-Eichenseer, PhDa,
- Holger Thiele, MDc,
- Samer Aldmour, MDd,
- Daniela Branzan, MDe,
- Dierk Scheinert, MDa and
- Sabine Steiner, MDa
- aDivision of Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany
- bDepartment of Angiology, Cardiovascular Center Bethanien, Frankfurt, Germany
- cDepartment of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- dDepartment of Vascular Surgery, Helios Park-Clinic Leipzig, Leipzig, Germany
- eDepartment of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
- ↵∗Address for correspondence:
Dr. Andrej Schmidt, Division of Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.
Objectives This study sought to report short- and long-term efficacy and safety outcomes of retrograde tibioperoneal access for endovascular treatment of chronic total occlusions (CTOs).
Background Antegrade recanalization of peripheral CTO is associated with a high failure rate and retrograde puncture of tibioperoneal arteries has been adopted to overcome this limitation.
Methods Within a retrospective single center cohort study, data of 554 infrainguinal occlusions were acquired in which a retrograde puncture of at least 1 infrapopliteal artery became necessary. Techniques used for access, retrograde lesion crossing, and antegrade treatment modalities were recorded. Next to short-term outcomes, long-term results through 4 years were described using survival analysis.
Results The majority of patients (71.5%) had critical limb ischemia (CLI) and occlusion locations were the femoropopliteal segment (35.9%), infrapopliteal segment (42.6%), or both segments (21.5%). Retrograde access was most commonly performed via the proximal (28%) or distal (34%) anterior tibial artery. Retrograde access could be established in 98.6% and subsequent lesion crossing was successful in 95.1%. Complications due to distal puncture were rare (3.3%). At 1 year, freedom from target lesion revascularization and restenosis were 74.6 ± 3.7% and 67.5 ± 4.4% in claudicants and 62.2 ± 2.8% and 36.0 ± 4.4% in CLI patients, respectively. Late complications at the distal puncture site after a median follow-up time of 234 days comprised 1 stenosis, 7 occlusions, and 3 clinically nonrelevant arteriovenous fistula occurring only in CLI patients.
Conclusions Retrograde tibioperoneal access is a safe option for recanalization of complex CTOs after a failed antegrade approach. Complications at the puncture site were rare.
Dr. Schmidt has received consulting and speaker honoraria from Abbott, CR Bard/BD, and Cook; received speaker honoraria from Boston Scientific, Cordis, and Medtronic; and has served as a consultant for Intactvascular, Reflow, and Upstream Peripheral. Dr. Bausback has served as a consultant for CR Bard. Dr. Piorkowski has received consulting and/or speaker honoraria from Abbott, CR Bard, Phillips IGTD, and WL Gore. Dr. Branzan has received minor travel grants support from Cook Medical; research grant support from Cook Medical, Jotec, and Bentley Innomed; and nonfinancial support from Medyria AG, LimFlow Medical, and Vivasure Medical Ltd. Dr. Scheinert has served as a consulting or advisory board member for Abbott, Biotronik, Boston Scientific, Cardionovum, Cook Medical, Cordis, CR Bard, Gardia Medical/Allium, Medtronic/Covidien, Philips, TriReme Medical, Trivascular, and Upstream Peripheral Technologies. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 14, 2019.
- Revision received May 8, 2019.
- Accepted June 4, 2019.
- 2019 American College of Cardiology Foundation
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