Ultrasound-guided retrograde tibial access through chronically occluded tibial arteries: a last resort recanalization technique.
Diagn Interv Radiol
; 28(6): 621-626, 2022 Nov.
Article
in En
| MEDLINE
| ID: mdl-36550764
ABSTRACT
PURPOSE We aimed to demonstrate the feasibility of ultrasound (US)-guided retrograde tibial access through chronically occluded tibial arteries as a bailout endovascular recanalization procedure in patients with critical limb ischemia (CLI). METHODS Fifty-one CLI patients with failed conventional antegrade tibiopedal recanalization required retrograde tibiopedal access in the same session. In all of these patients, the target tibial artery was chronically occluded in at least the distal half of the cruris. Access attempts were made under real-time US by a single operator experienced in image-guided vascular access procedures. Fluoroscopy was used only as an adjunct during advancement of a 0.018 inch guidewire. If access to the artery was successful by the retrograde route, the occluded artery was usually predilated with a 2 mm balloon, and the standard endovascular treatment was mostly performed through the antegrade route. RESULTS Patients had athereosclerosis (n=35) or Buerger's disease (n=32) and presented with Rutherford category IV and category V. Successful placement of a guidewire in the occluded artery lumen was achieved in 81% of all patients, whereas, treatment success, i.e. angiographic demonstration of in-line flow at the end of procedure, was achieved in 49%. No significant procedure-related complications were observed. Of 33 limbs with initially successful endovascular treatment, 6 required minor and 1 required major amputation during follow-up. CONCLUSION US-guided retrograde access through completely occluded tibial arteries is difficult but feasible. Half of the tibial arteries that could not be recanalized otherwise were converted to successful recanalization by this method.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Arterial Occlusive Diseases
/
Peripheral Arterial Disease
/
Endovascular Procedures
Type of study:
Observational_studies
Limits:
Humans
Language:
En
Journal:
Diagn Interv Radiol
Journal subject:
DIAGNOSTICO POR IMAGEM
/
RADIOLOGIA
Year:
2022
Document type:
Article
Affiliation country:
Turkey