Retrograde Angioplasty: A Simple Bailout Technique for Failed Antegrade Crossing of Femoropopliteal and Tibial Lesions | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 112, Volume 98, Issue 1, January 2025, Page 789-795 PDF (567.4 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejhm.2025.411584 | ||||
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| Abstract | ||||
| Background: Endovascular revascularization is the preferred treatment for chronic limb-threatening ischemia (CLTI). However, standard antegrade approaches often fail in complex infragenicular occlusions. Retrograde tibial artery access has emerged as a viable alternative, offering improved technical success rates and procedural feasibility. Objective: This study aimed to evaluate the feasibility, safety, and early outcomes of retrograde ankle tibial artery access in patients with below-the-knee CLTI who failed conventional antegrade recanalization. Patients and methods: This prospective study included 19 patients (and 68% were males) with a mean age of 71.3 ± 11.8 years with Rutherford class 4–5 CLTI who underwent endovascular recanalization via retrograde tibial access after failed antegrade attempts. Technical success, procedural complications, and six-month outcomes, including patency and limb salvage, were assessed. Results: Retrograde tibial access was successfully established in 18 patients (95%), with lesion crossing and revascularization achieved in 16 (84%). The six-month primary and secondary patency rates were 68% and 89%, respectively. Amputation-free survival at six months was 79%, with major amputations required in three cases (16%). Retrograde access-related complications occurred in four patients (21%) but were minor and managed conservatively. No procedure-related mortality was reported. Conclusion: Retrograde tibial artery access is a safe and effective bailout strategy for failed antegrade revascularization in CLTI patients, demonstrating high technical success and acceptable long-term patency. This approach may serve as a valuable alternative to more complex techniques in challenging infragenicular occlusions. | ||||
| Keywords | ||||
| Retrograde angioplasty; Chronic limb-threatening ischemia; Tibial artery access; Endovascular revascularization; Critical limb ischemia | ||||
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