Goltz J P, Planert M, Horn M, Wiedner M, Kleemann M, Barkhausen J, Stahlberg E
Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany.
Department for Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany.
Rofo. 2016 Oct;188(10):940-8. doi: 10.1055/s-0042-110101. Epub 2016 Jul 13.
To evaluate the safety and technical and clinical success of endovascular below-the-knee (BTK) artery revascularization by a retrograde transpedal access.
We retrospectively identified 16/172 patients (9.3 %) with endovascular BTK revascularization in whom a transfemoral approach had failed and transpedal access had been attempted. The dorsal pedal (n = 13) or posterior tibial (n = 3) artery was accessed using a dedicated access set and ultrasound guidance. The procedure was finished in antegrade fashion by plain old balloon angioplasty (POBA). Comorbidities, vessel diameter and calcification at the access site were recorded. The analyzed outcomes were technical success, procedural complications, procedure time, crossing (guidewire beyond lesion and intra-luminal) and procedural (residual stenosis < 30 % after POBA) success, and limb salvage.
Diabetes, coronary artery disease and hypertension were present in 15 patients (93.8 %), and both renal impairment and previous amputations in 7 (43.8 %). Pedal access vessel calcification was present in 5/16 patients (31.3 %). The mean diameter was 1.75 +/-0.24 mm. The procedure time was 92.4 +/-23 min. The success rate for achieving retrograde access was 100 %. Retrograde crossing was successful in 12/16 patients (75.0 %). Procedural success was observed in 10/16 patients (68.8 %). Minor complications occurred in 2/16 patients (12.5 %). The rate of limb salvage was 72.9 %, and the overall survival was 100 % at 12 months. Major amputations after revascularization occurred in 2/16 patients (12.5 %).
If an antegrade transfemoral approach to BTK lesions fails, a retrograde transpedal approach may nevertheless facilitate treatment. This approach appears to be safe and offers high technical and acceptable clinical success rates.
• Retrograde approaches via transpedal or transtibial vessels are safe and offer high technical success.• One problem after technically successful puncture might be the re-entry following subintimal retrograde lesion crossing.• After a failed attempt at antegrade revascularization of a BTK occlusion, a retrograde approach should be performed. Citation Format: • Goltz JP, Planert M, Horn M et al. Retrograde Transpedal Access for Revascularization of Below-the-Knee Arteries in Patients with Critical Limb Ischemia after an Unsuccessful Antegrade Transfemoral Approach. Fortschr Röntgenstr 2016; 188: 940 - 948.
评估经逆行经足入路行膝下（BTK）动脉血管腔内再血管化治疗的安全性、技术成功率及临床成功率。
我们回顾性纳入了16例（占172例患者的9.3%）接受过血管腔内BTK再血管化治疗且经股动脉入路失败并尝试经足入路的患者。使用专用入路套件并在超声引导下穿刺足背动脉（n = 13）或胫后动脉（n = 3）。通过普通球囊血管成形术（POBA）以顺行方式完成手术。记录合并症、入路部位血管直径及钙化情况。分析的结果包括技术成功率、手术并发症、手术时间、导丝通过病变部位及管腔内通过情况、手术成功率（POBA后残余狭窄<30%）及肢体挽救情况。
15例患者（93.8%）患有糖尿病、冠状动脉疾病和高血压，7例患者（43.8%）同时存在肾功能损害和既往截肢史。16例患者中有5例（31.3%）存在足入路血管钙化。平均血管直径为1.75±0.24mm。手术时间为92.4±23分钟。逆行入路成功率为100%。16例患者中有12例（75.0%）逆行通过病变成功。16例患者中有10例（68.8%）手术成功。16例患者中有2例（12.5%）发生轻微并发症。肢体挽救率为72.9%，12个月时总生存率为100%。血管再通后2例患者（12.5%）行大截肢术。
如果经股动脉顺行入路治疗BTK病变失败，逆行经足入路仍可能有助于治疗。该入路似乎是安全的，技术成功率高，临床成功率也可接受。
• 通过经足或经胫血管的逆行入路是安全的，技术成功率高。• 技术穿刺成功后一个问题可能是内膜下逆行通过病变后的再入路问题。• 在BTK闭塞顺行血管再通尝试失败后，应采用逆行入路。引用格式：• Goltz JP, Planert M, Horn M等。经股动脉顺行入路失败后，逆行经足入路治疗严重肢体缺血患者膝下动脉再血管化。Fortschr Röntgenstr 2016; 188: 940 - 948。
