Stern Jordan R, Cafasso Danielle E, Connolly Peter H, Ellozy Sharif H, Schneider Darren B, Meltzer Andrew J
New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; Stanford University School of Medicine, Stanford, CA.
New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY.
Ann Vasc Surg. 2019 Feb;55:131-137. doi: 10.1016/j.avsg.2018.08.072. Epub 2018 Sep 11.
Retrograde arterial access (RA) of the popliteal, tibial, or pedal arteries may facilitate endovascular treatment of complex infrainguinal lesions in patients with critical limb ischemia (CLI). Here, we assess the safety and efficacy of this technique.
A retrospective review of prospectively collected institutional data (consecutive M2S entries) was performed to identify patients with CLI undergoing peripheral vascular intervention from February 2012 through December 2017. Demographics, comorbidities, procedural characteristics, and outcomes were analyzed, and comparisons were made between outcomes of patients undergoing RA and those undergoing a standard antegrade access (SA) approach.
Five hundred sixty-six patients were identified, of whom 26 (4.6%) underwent RA. Of these, 4 were accessed via the popliteal artery (15.4%), 13 via the tibial vessels above the ankle (50.0%), and 9 via pedal vessels (34.6%). RA facilitated procedural success in 96.2% of cases. There were no instances of distal embolization, perforation, or loss of distal target with RA. Primary, primary assisted, and secondary patency rates were consistently lower for RA patients than for SA patients, as was limb salvage and amputation-free survival. No difference was seen in overall survival.
RA represents a viable and safe option for revascularization when SA fails. Although outcomes are poorer than SA, this technique can be useful in CLI patients, especially when open surgical revascularization is not an option.
腘动脉、胫动脉或足背动脉的逆行动脉入路（RA）可能有助于对严重肢体缺血（CLI）患者的复杂下肢病变进行血管内治疗。在此，我们评估该技术的安全性和有效性。
对前瞻性收集的机构数据（连续的M2S条目）进行回顾性分析，以确定2012年2月至2017年12月期间接受外周血管介入治疗的CLI患者。分析患者的人口统计学、合并症、手术特征和预后，并比较接受RA治疗的患者与接受标准顺行入路（SA）治疗的患者的预后。
共识别出566例患者，其中26例（4.6%）接受了RA治疗。其中，4例通过腘动脉入路（15.4%），13例通过踝关节以上的胫血管入路（50.0%），9例通过足背血管入路（34.6%）。RA在96.2%的病例中促进了手术成功。RA治疗未出现远端栓塞、穿孔或远端靶点丢失的情况。RA患者的一期、一期辅助和二期通畅率始终低于SA患者，肢体挽救率和无截肢生存率也是如此。总生存率无差异。
当SA失败时，RA是一种可行且安全的血管重建选择。尽管预后比SA差，但该技术对CLI患者可能有用，尤其是在无法进行开放手术血管重建的情况下。
