Tibiopedal access for crossing of infrainguinal artery occlusions: a prospective multicenter observational study.

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11-08-2022
Biology

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Tibiopedal access for crossing of infrainguinal artery occlusions: a prospective multicenter observational study.

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Tutorconsortium358 Tutorconsortium358 · Answer 1 · 2022-08-16T19:16:30+02:00

This study was to present a prospective, multicenter, observational study on the security and efficiency of tibiopedal access and retrograde crossing in the treatment of infrainguinal chronic complete occlusions (ClinicalTrials.gov identifier NCT01609621) (CTOs).

From May 2012 to July 2013, 197 patients (mean age 7111 years, range 41-93; 129 men) who met the inclusion criterion of at least one CTO for which a retrograde crossing surgery was scheduled or became necessary were prospectively enrolled at 12 sites across the globe.
The population was made up of 133 (67.5%) patients with critical limb ischemia and 64 (32.5%) claudicants (Rutherford classifications 2/3).
In 132 (67.0%) cases, an initial antegrade attempt to cross had been made before the tibiopedal attempt.
The operator chose the access, crossing of the retrograde lesion, and treatment methods.
Following the procedure, 30 days of follow-up data were collected.

What were the results observed?

Of the 197 patients, 184 (93.4%) had successful technical tibiopedal accesses, while 157 (85.3%) had successful technical occlusion crossings.
There were more unsuccessful access attempts among women (9 of 13 failures).
Between the sexes, the rate of successful crossing was almost equal (84.7% (50/59) for women and 85.6% (107/125) for males).
The success rate of the access was 92.4% (122/132) following a failed antegrade access attempt compared to 95.4% (62/65) in individuals who had made a primary tibiopedal attempt (p=0.55).
Technical success did not differ substantially dependent on a prior unsuccessful antegrade attempt.
Similarly, 82.8% (101/122) of patients with failed antegrade access succeeded in crossing, compared to 90.3% (56/62) of patients who had never attempted antegrade access (p=0.19).
11 (5.6%) incidences of minor access site problems occurred; no patient experienced access vessel thrombosis, compartment syndrome, or surgical revascularization.

Conclusion of the observational study:

In patients with severe lower limb ischemia, tibiopedal access appears to be safe and can be utilized successfully to cross infrainguinal lesions.

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