Department of Radiology, Okan University Hospital, Aydınlı Cad. No: 2 Okan Universitesi Hastanesi İçmeler, Tuzla, İstanbul, Turkey.
Department of Radiology, Okan University Hospital, Aydınlı Cad. No: 2 Okan Universitesi Hastanesi İçmeler, Tuzla, İstanbul, Turkey.
J Vasc Interv Radiol. 2021 Feb;32(2):164-172. doi: 10.1016/j.jvir.2020.08.034. Epub 2020 Nov 25.
To evaluate the feasibility and technical outcomes of retrograde access via occluded pedal arteries in endovascular treatment of critical limb ischemia (CLI) when the conventional antegrade approach fails.
One hundred fifty-one patients with CLI (age 69 y ± 10.5; 116 men) who were not surgical candidates and were treated via retrograde pedal access between January 2016 and January 2018 were evaluated retrospectively. Seventy patients in whom retrograde access was performed through occluded arteries constituted the occluded group, and 81 patients who were treated via retrograde access from patent arteries constituted the nonoccluded group. Pedal access success, lesion crossing success, angiographic success, overall technical success, and procedure-related complications were evaluated and compared between groups.
Pedal access success (74 of 78 vs 83 of 87 attempts; P = .873) and lesion crossing success (64 of 78 vs 77 of 87 lesions; P = .340) were comparable between subgroups. Angiographic success (54 of 78 vs 77 of 87 lesions; P = .012) and overall technical success (48 of 70 vs 72 of 81 patients; P = .004) rates were lower in the occluded group. Procedure-related complications were similar between groups (P = .096).
Retrograde pedal access from occluded pedal arteries is a feasible option when an antegrade approach fails in endovascular treatment of CLI. Although it has lower technical success, its use enables angiosome-directed therapy and has the potential to improve the outcomes of the procedure.
评估逆行经闭塞的足动脉入路在传统顺行入路失败时用于治疗严重肢体缺血（CLI）的可行性和技术结果。
回顾性评估了 2016 年 1 月至 2018 年 1 月期间，151 例不适合手术的 CLI 患者（年龄 69 岁±10.5；116 例男性）接受逆行足动脉入路治疗。其中 70 例通过闭塞动脉进行逆行入路的患者为闭塞组，81 例通过通畅动脉进行逆行入路的患者为非闭塞组。评估并比较两组患者的足动脉入路成功率、病变跨越成功率、血管造影成功率、整体技术成功率和与手术相关的并发症。
两组患者的足动脉入路成功率（74/78 例与 83/87 例尝试；P=.873）和病变跨越成功率（64/78 例与 77/87 例病变；P=.340）相当。闭塞组的血管造影成功率（54/78 例与 77/87 例病变；P=.012）和整体技术成功率（48/70 例与 72/81 例患者；P=.004）较低。两组患者的手术相关并发症发生率相似（P=.096）。
当顺行入路治疗 CLI 失败时，逆行经闭塞的足动脉入路是一种可行的选择。虽然它的技术成功率较低，但它可以实现血管分布区导向治疗，并有潜力改善手术结果。
