Gündoğmuş Cemal Aydın, Özen Atalay Hande, Samadli Vugar, Oğuzkurt Levent
Koç University Hospital, Department of Radiology, İstanbul, Türkiye.
Diagn Interv Radiol. 2025 Sep 8;31(5):482-488. doi: 10.4274/dir.2024.242833. Epub 2024 Sep 9.
Peripheral arterial disease (PAD) is increasingly prevalent, particularly among the aging population. Retrograde tibiopedal access (RTPA) has emerged as a useful endovascular treatment for PAD. However, there is limited research examining factors that influence the efficacy of RTPA. To investigate factors affecting the access, crossing, and recanalization success rates of RTPA for infrapopliteal PAD treatment.
A retrospective study was conducted on 720 patients who underwent endovascular treatment for PAD. Of these, 104 patients (mean age: 65.5 ± 16.2; 89 men) with 131 RTPA trials were included in the final evaluation. The disease and its duration, Rutherford score, smoking status, access site, and its occlusion status, access, crossing, and recanalization success were noted. Data were analyzed using Pearson's chi-square and Mann-Whitney U tests and multivariate logistic regression to evaluate the impact of various factors on success rates.
The access success rate was 82.6%, the crossing success rate was 95.4%, and the recanalization success rate was 74%. Access success was significantly higher when the dorsal pedal artery (DPA) was the access artery compared with the posterior tibial artery (91.3% vs. 74.2%, = 0.009). Access success was notably lower in patients with thromboangiitis obliterans compared with patients with diabetes mellitus (DM) and non-DM atherosclerosis (68.6% vs. 90.3% and 80.3%, = 0.019). Recanalization success was higher when the puncture site was non-occluded (76.7% vs. 53.5%, = 0.023).
The study suggests that RTPA is a generally effective and safe technique for infrapopliteal PAD treatment. The most favorable outcomes are observed in individuals with DM who have a non-occluded DPA at the puncture site. Recanalization success is only affected by the patency of the artery at the puncture site.
These findings offer targeted guidance for clinicians and highlight areas requiring further investigation.
外周动脉疾病（PAD）日益普遍，尤其是在老年人群中。逆行胫足部入路（RTPA）已成为一种用于治疗PAD的有用的血管内治疗方法。然而，研究影响RTPA疗效的因素的研究有限。旨在调查影响RTPA治疗腘动脉以下PAD时入路、通过和再通成功率的因素。
对720例行PAD血管内治疗的患者进行回顾性研究。其中，104例患者（平均年龄：65.5±16.2岁；89例男性）共进行了131次RTPA试验，纳入最终评估。记录疾病及其病程、卢瑟福评分、吸烟状况、入路部位及其闭塞状态、入路、通过和再通成功率。使用Pearson卡方检验和Mann-Whitney U检验以及多因素逻辑回归分析数据，以评估各种因素对成功率的影响。
入路成功率为82.6%，通过成功率为95.4%，再通成功率为74%。与胫后动脉相比，以足背动脉（DPA）作为入路动脉时，入路成功率显著更高（91.3%对74.2%，P = 0.009）。与糖尿病（DM）患者和非DM动脉粥样硬化患者相比，血栓闭塞性脉管炎患者的入路成功率明显更低（68.6%对90.3%和80.3%，P = 0.019）。当穿刺部位未闭塞时，再通成功率更高（76.7%对53.5%，P = 0.023）。
该研究表明，RTPA是一种治疗腘动脉以下PAD的总体有效且安全的技术。在穿刺部位DPA未闭塞的DM患者中观察到最有利的结果。再通成功率仅受穿刺部位动脉通畅情况的影响。
这些发现为临床医生提供了有针对性的指导，并突出了需要进一步研究的领域。
