Pedal access in critical limb ischemia.

Critical limb ischemia (CLI) commonly involves popliteal and infrapopliteal arterial occlusions. Surgical revascularization may be limited by poor distal targets, lack of autologous vein, and co morbid conditions. Endovascular therapy may be an option even in this group of patients with no surgical options, but is limited by the need to first cross these chronic total occlusions. Lesions that are uncrossable in antegrade fashion are often easily crossed via retrograde approach. The pedal approach (via anterior tibial, posterior tibial, or peroneal arteries) is a viable approach in limb salvage interventions where occlusions cannot be crossed with antegrade approach. A 13-step technique utilizing transpedal approach in my first 228 patients treated by this approach who had presented with CLI and had failed attempts at antegrade crossing of the occlusions is described. In this group of patients, transpedal approach was only utilized in patients with CLI. No claudicants were included. The pedal arteries were accessed successfully in 217/228 (95%) patients. Once pedal access was achieved successful intervention was accomplished in 199/217 (93%). There were no bleeding complications and only one pedal occlusion.