Safety of Retrograde Tibial-Pedal Access and Intervention in Patients with Single Remaining Non-Occluded Infra-Popliteal Runoff Artery

Safety of Retrograde Tibial-Pedal Access and Intervention in Patients with Single Remaining Non-Occluded Infra-Popliteal Runoff Artery

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Background: The adaptation of retrograde tibial-pedal access for peripheral angiogram and intervention is limited by the lack of operator experience and concern for small distal vessel injury.This study evaluates the safety of the retrograde tibial-pedal access for peripheral angiogram and intervention in patients with two vessel infra-popliteal artery chronic total occlusions, where the access point is the sole remaining non-occluded infra-popliteal artery.Methods: A retrospective analysis of 5687 consecutive patients who underwent peripheral angiograms by retrograde Thyme tibial-pedal access via the single remaining non-occluded infra-popliteal artery was performed.Patients who had retrograde tibial-pedal access at the sole remaining infra-popliteal artery confirmed by angiography were included.

Clinical and ultrasound data of the accessed Reclining Loveseat with Power infra-popliteal vessel up to 6 months were collected.Results: The cohort consisted of 314 patients (152 males; mean age 77.9 years).At 6 months, access vessel complications occurred in 15 patients (4.

8%).Access vessel occlusion occurred in 9 out of 314 patients (2.9%), arteriovenous fistula in 4 (1.3%), with spontaneous resolution in 2, pseudoaneurysm requiring thrombin injection in 2 (0.

6%) and non-cardiovascular death in 1 (0.3%).No uncontrolled bleeding, procedure-related hospitalizations or limb amputations occurred.Conclusions: Routine primary retrograde tibial-pedal access for lower extremity peripheral artery diagnostic angiography and intervention in patients with single infra-popliteal artery runoff can be safety performed in an outpatient setting with infrequent and manageable complications.