RETRO-GRADE TRANS PEDAL AND TIBIAL ARTERY ACCESS FOR REVASCULARIZATION OF INFRA-POPLITEAL ARTERIAL OCCLUSIVE DISEASE

Abstract

Background: Peripheral artery disease (PAD) has reached pan-demic proportions. Percutaneous recanalization of the affected artery is the most important alternative to surgery and appears equivalent to surgery in the management of patients with critical limb ischemia (CLI).
Objectives: to evaluate limb salvage after recanalization of lower extremity arteries using retrograde trans-pedal/tibial access using different modalities (US guided, road mapping and cut down) in patients with CLI.
Methods: This prospective study included 50 patients of Beni-Suef university hospital with infra-popliteal atherosclerotic occlusive arterial disease. Diagnosis of the underlying arterial ischemia in each patient will be determined from; patient history records and physical exams and using color Doppler ultrasonograpy (US) or CT angiography.
Results: 45 patients suffered from Diabetes (90%), 35 patients were cigarettes smokers (70%), 35 patients had dyslipidemia (70%), 30 patients had hypertension (60%), 15 patients suffered from ischemic heart diseases (30%), while 10 patients had renal impairment (20%), 25 patients with failed antegrade (femoral) angioplasty (50%), 15 patients suffered from tissue loss (30%) and 10 patients suffered from rest pain (20%). we used transpedal access in 50 cases, through anterior tibial artery in 30 limbs (60%), and through dorsalis pedis artery in 11 limbs (22%) and posterior tibial artery in 9 limbs (18%) with technical success rate (66%). 2 case developed hematoma (4%) 1 case developed infection (2%) and Perforation in 1 case, there were no major complications.
Conclusion: Retrograde pedal/tibial artery access is a promising alternative for patients in whom conventional endovascular techniques failed to achieve recanalization of the tibial vessels.