Combined retrograde–antegrade arterial wiring: Peroneal artery can be a bridge to cross infrapopliteal Trans Atlantic Inter Society Consensus D lesions

Abstract

Background

Percutaneous transluminal angioplasty of complex infrapopliteal lesions might be a true and complex challenge. Success rates remain suboptimal when employing standard approaches. Thus, recanalization techniques for infrapopliteal disease remain a seat of continuous evolution.

Aim of the study

We report our results of Trans Atlantic Inter Society Consensus D infrapopliteal disease recanalization using combined antegrade-retrograde approach through peroneal artery branches.

Patients and methods

A total of 27 patients with infrapopliteal Trans Atlantic Inter Society Consensus D lesions underwent recanalization of at least one of the tibial arteries by combined retrograde–antegrade route using the peroneal artery normal anastomosis channels.

Results

Technical success was achieved in 22 patients who were followed for 6–24 months. Healing of ischemic ulcers or spontaneous separation of ischemic gangrenous patches in 13 patients. Minor amputation in nine patients. No major amputation in the follow-up period.

Conclusion

Although demanding, the technique can be reserved for selected cases with failed antegrade recanalization. This technique is valuable when a proximal occlusion is not crossable, when a dissection flap or a perforation in the proximal portion of a target vessel hinders guide-wire advancement. This technique may represent a feasible endovascular option to avoid second distal puncture exhausting the landing zone of a future distal bypass.

Keywords

Retrograde antegrade revascularization infrapoploiteal disease peroneal artery

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References

van Overhagen

Spiliopoulos

Tsetis

. Below the knee interventions. Cardiovasc Intervent Radiol 2013; 36: 302–311.

Norgren

Hiatt

Dormandy

. Inter-Society Consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg 2007; 3(suppl 1): S1–S75.

Montero-Baker

Schmidt

Braunlich

. Retrograde approach for complex popliteal and tibioperoneal occlusions. J Endovasc Ther 2008; 15: 594–604.

Bolia

. Subintimal angioplasty in lower limb ischaemia. J Cardiovasc Surg (Torino) 2005; 46: 385–394.

Fusaro

Agostoni

Biondi-Zoccai

. “Trans-collateral” angioplasty for a challenging chronic total occlusion of the tibial vessels: a novel approach to percutaneous revascularization in critical lower limb ischemia. Cathet Cardiovasc Interv 2008; 71: 268–272.

Graziani

Silvestro

Monge

. Transluminal angioplasty of peroneal artery branches in diabetics: initial technical experience. Cardiovasc Interv Radiol 2008; 31: 49–55.

Graziani

Morelli

. Combined retrograde–antegrade arterial recanalization through collateral vessels: redefinition of the technique for below-the-knee arteries. Cardiovasc Intervent Radiol 2011; 34: S78–S82.

Yeh

Tsai

Huang

. Dual vascular access for critical limb ischemia: immediate and follow-up results. Catheter Cardiovasc Interv 2011; 77: 296–302.

Saito

. Different strategies of retrograde approach in coronary angioplasty for chronic total occlusion. Catheter Cardiovasc Interv 2008; 71: 8–19.

10.

Spiliopoulos

Katsanos

Karnabatidis

. Cryoplasty versus conventional balloon angioplasty of the femoropopliteal artery in diabetic patients: long-term results from a prospective randomized single-center controlled trial. Cardiovasc Intervent Radiol 2010; 33: 929–938.

11.

Graziani

Silvestro

Bertone

. Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. Eur J Vasc Endovasc Surg 2007; 33: 453–460.

12.

Chun

Markose

Bolia

. Developments in subintimal angioplasty in the infrainguinal segment. J Cardiovasc Surg (Torino) 2010; 51: 213–213.

13.

BASIL Trial Participants. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 2005; 366: 1925–1934.

14.

Rogers

Dattilo

Garcia

. Retrograde approach to recanalization of complex tibial disease. Catheter Cardiovasc Interv 2011; 77: 915–925.

15.

Iida

Soga

Yamauchi

. Clinical efficacy of endovascular therapy for patients with critical limb ischemia attributable to pure isolated infrapopliteal lesions. J Vasc Surg 2013; 57: 974e81–974e81.

16.

Shimada

Kino

Yano

. Transcollateral retrograde approach with rendezvous technique for recanalization of chronically occluded tibial arteries. J Endovasc Ther 2012; 19: 620e6–620e6.

17.

Spinosa

Leung

Harthun

. Simultaneous antegrade and retrograde access for subintimal recanalization of peripheral arterial occlusion. J Vasc Interv Radiol 2003; 14: 1449–1454.

18.

Ferraresi

Palena

Mauri

. Tips and tricks for a correct “endo approach”. J Cardiovasc Surg 2013; 54: 685–711.

19.

Schmidt

Ulrich

Winkler

. Angiographic patency and clinical outcome after balloon angioplasty for extensive infrapopliteal arterial disease. Catheter Cardiovasc Interv 2010; 76: 1047–1054.

20.

Ballotta

Da Giau

Gruppo

. Infrapopliteal arterial revascularization for critical limb ischemia: is the peroneal artery at the distal third a suitable outflow vessel? J Vasc Surg 2008; 47: 952–959.