|
Back to 2015 Annual Symposium Program
Initial Experience with Infrageniculate Access for Retrograde Endovascular Interventions (REI) for Chronic Lower Extremity Ischemia
Ashraf Taha, MD, Luke Marone, MD, Efthymios D. Avgerinos, MD, Timothy Wu, MD, George AlKhoury, MD, Michael Singh, MD, Geetha Jeyabalan, MD, Michel Makaroun, MD, Rabih A. Chaer, MD.
University of Pittsburgh, Pittsburgh, PA, USA.
OBJECTIVES: Retrograde infrageniculate access is an alternative treatment strategy for patients that failed antegrade endovascular intervention. This study examines the modes of failure and outcomes of REI for lower extremity ischemia.
METHODS: This was a retrospective single center review of REI from 2012-2014. Indications for intervention, comorbidities, complications, procedural success, limb outcomes, and mortality were analyzed. Technical failure was defined as the inability to complete the procedure due to failed access or unsuccessful recanalization. Infrageniculate access was obtained with ultrasound or angiographic roadmap guidance. Patency rates were calculated for technically successful interventions.
RESULTS: 37 patients presenting with critical limb ischemia (81%) or disabling claudication (19%) underwent sheathless REI after failed antegrade recanalization of TASC D infrainguinal lesions. Mean follow up was 8 months (range 1-27). There were 14(38%) femoropoliteal, 5 (14%) tibial, and 10(27%) multilevel interventions. Access sites included the dorsalis pedis (27%), mid-calf peroneal (27%), anterior tibial (19%), posterior tibial (24%) and popliteal arteries (3%). Overall technical success was achieved in 22 (59%) patients: technical failure rate (41%) included failed access (11%) and failed recanalization (30%). Of the 15 technical failures, 4 underwent successful antegrade endovascular interventions, 8 bypasses, 2 major amputations, and one patient was managed conservatively. The 1-year primary, assisted primary, and secondary patency rates were 77%, 77%, and 97%, respectively. The rate of reintervention was 23%, the majority consisting of antegrade endovascular interventions for symptomatic restenosis. At one year, limb salvage and survival rates were 85% and 77% by KM analysis, comparable to published reports of antegrade interventions for CLI. There were no access site complications or periprocedural deaths.
CONCLUSIONS: Infrageniculate access for REI can result in similar limb salvage and patency rates as antegrade interventions, and does not compromise the access site. Technical failure is high in this initial experience and is mostly due to failed recanalization. Limb salvage may be achieved after technical failure with either repeat antegrade intervention or surgical bypass.
Patient Characteristics | N (37) | % | Mean age (yrs+/-SD)
Male
Smoker | 70.5±12.17
17
28 | 46
76 | | Co-morbidities | | | CAD
CHF
Hypertension
Renal Insufficiency
Dialysis
Stroke
Cancer
Dyslipidemia
DM
COPD | 24
12
30
12
4
5
7
26
21
15 | 65
32
81
32
11
14
19
70
57
41 |
Back to 2015 Annual Symposium Program
|
