Retrograde Approach as an Alternative to Antegrade Approach in Peripheral Arterial Angioplasty for Treatment of Critical Lower Limb Ischemia

Abstract

Background: Peripheral arterial disease (PAD) is a worldwide problem that has the potential to cause loss of limb or even loss of life. The prevalence of this vascular global problem in the general population is increased nowadays with increasing of prevalence of its risk factors as diabetes mellitus, hypertension, smoking, hyperlipidemia and others. Objective: to determine the feasibility (technically and outcome) of retrograde approach after failure of antegrade technique in peripheral arterial angioplasty for the treatment of critical lower limb ischemia. Patients and Methods: In this study, we worked on 25 patients who failed to be revascularized antegrade. Variant of accesses was created; popliteal, anterior tibial and posterior tibial. Ultrasound-guided puncture was needed in some of these cases. Results: Technically, 24 out of the 25 patients (96%) showed technical success, as the puncture was done and the lesion was crossed and treated adequately through a retrograde access. At the end of the 6-month period of follow up, the mean of ABI increased from 0.38 before the intervention to 0.68, this 0.3 rising in the ABI is significant and means that the procedure had a satisfactory outcome in short-term follow up period. Conclusion: The retrograde peripheral angioplasty whatever through popliteal artery or trans-tibial is feasible, safe, and successful in treating infra-inguinal arterial lesions when indicated, with satisfactory results during a short-term period of follow up.