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A Propensity Score Matching Analysis Of The Impact Of Retrograde Access During Endovascular Revascularization
Andrew Min, BSE1, Michael Daidone, BA
2, Darya Dehkan, BS
2, Ageliki Vouyouka, MD
1, Windsor Ting, MD
1, Michael Marin, MD
1, Peter Faries, MD
1, William Beckerman, MD
2, Ajit Rao, MD
1.
1Icahn School of Medicine at Mount Sinai, New York, NY, USA,
2Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA.
OBJECTIVES: In treatment of Peripheral Artery Disease (PAD), the contralateral femoral artery is the most utilized access point. However, for some patients, retrograde access from a tibial and/or pedal vessel is used to facilitate lesion crossing. This study aims to explore the impact of retrograde stenting on longitudinal outcomes using a Propensity Score Matching analysis to emulate a randomized controlled trial.
METHODS: This retrospective analysis included unique patients who underwent endovascular revascularizations from two institutions from 2014 to 2022. Retrograde access patients were defined as patients who underwent endovascular access from the anterior tibial, posterior tibial, peroneal, or dorsalis pedis artery. Major Adverse Limb Events (MALE) were defined as open arterial bypass surgery, minor amputation, or major amputation. Previous studies have shown that chronic kidney disease (CKD), gangrene, history of previous PAD surgery, chronic total occlusion (CTO) as a lesion type, and number of patent preoperative tibial vessel runoffs are significant in predicting need for retrograde access. Propensity score matching was performed using these covariates, as well as age and gender. A full matching method was used to match covariates to prevent discarding many patients. Univariate logistic regression with MALE, reintervention, and death were performed to estimate the effect size of retrograde access.
RESULTS: After matching, there were 57 retrograde access patients and 276 antegrade access patients. Figure 1 shows that the absolute mean differences of covariates between the two groups decreased to below 0.1 after propensity score matching, indicating that covariate balance between the retrograde and antegrade groups was achieved well. Univariate logistic regression demonstrated that retrograde access did not result in a higher or lower odds ratio of MALE (OR=1.32, CI=[0.67-2.51], p=0.4), reintervention (OR=1.88, CI=[0.97-3.73], p=0.065), or death (OR=1.74, CI=[0.84-3.46], p=0.12).
CONCLUSIONS: This propensity score matching study demonstrates that retrograde access does not change the likelihood of adverse longitudinal outcomes. Therefore, retrograde access is a viable option for lesion treatment when antegrade crossing is not possible. However, this study is limited by its sample size, and the elevated odds ratios for adverse longitudinal outcomes warrant future investigation into the impact of retrograde access.
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