Dzhanelidze St. Petersburg Research Institute for Emergency Care, St. Petersburg, Russia.
Petrozavodsk State University, Petrozavodsk, Russia.
Khirurgiia (Mosk). 2021(6):54-62. doi: 10.17116/hirurgia202106154.
To evaluate safety and technical efficiency of primary retrograde distal access for endovascular interventions in patients with lower limb ischemia.
A prospective analysis included 25 endovascular procedures via primary retrograde distal access in 23 patients with chronic obliterating diseases of lower limb arteries. Occlusive lesion of femoral-popliteal segment was observed in 68% of cases, occlusion of at least one tibial artery was also found in 68% of cases. In 44% of cases, occlusive lesion was localized at several levels. Percutaneous intervention via anterior tibial artery or dorsalis pedis artery was performed in 68% of cases, posterior tibial artery - 24% of cases, peroneal artery - 8% of cases. We used 2 accesses in 92% of cases (the main one for intervention and additional one for angiography). In 8% of cases, intervention was carried out through a single access. Angiosome artery was punctured in 65% of cases. The only patent tibial vessel was used in 20% of cases. In 24% of cases, we performed antegrade recanalization of 'adjacent' tibial artery via distal access.
Primary retrograde distal access was successfully performed in 100% of cases. Retrograde revascularization was not successful in all cases (successful recanalization rate 96%, retrograde intervention rate - 92%). Femoral access was performed in 8% of cases. Antegrade blood flow through at least one tibial artery was restored in all cases. Direct revascularization of the affected angiosome was performed in 15 patients with foot necrosis, indirect revascularization through collaterals - in 5 patients. Local complications of surgical access occurred in 12% of cases.
Endovascular revascularization via primary retrograde distal access was technically effective in most cases. There were no complications with systemic consequences.
评估经原发性逆行远端入路对下肢缺血患者进行血管内介入治疗的安全性和技术效率。
前瞻性分析纳入 23 例慢性下肢动脉闭塞性疾病患者的 25 例经原发性逆行远端入路的血管内手术。68%的病例观察到股腘段闭塞性病变，68%的病例也发现至少一条胫骨动脉闭塞。44%的病例存在多个水平的闭塞性病变。68%的病例经前胫动脉或足背动脉行经皮介入治疗，24%的病例经后胫动脉，8%的病例经腓动脉。92%的病例使用 2 个入路（主要用于介入治疗，另一个用于血管造影），8%的病例仅使用单个入路。65%的病例穿刺血管弓动脉，20%的病例仅使用唯一通畅的胫骨血管。24%的病例通过远端入路对“相邻”胫骨动脉进行顺行再通。
100%的病例成功实施了原发性逆行远端入路。并非所有病例都能实现逆行再通（成功再通率 96%，逆行介入率 92%）。8%的病例行股动脉入路。所有病例均恢复至少一条胫骨动脉的顺行血流。15 例足部坏死患者行受累血管弓直接血运重建，5 例患者行侧支间接血运重建。12%的病例发生手术入路局部并发症。
经原发性逆行远端入路进行血管内再通在大多数病例中技术上是有效的。无全身性并发症。
