Tibiopedal Access for Crossing of Infrainguinal Artery Occlusions
| Autor: | Yazan Khatib, Marco Manzi, Thomas Zeller, Fadi Saab, Adam R. Shields, George L. Adams, Luis Mariano Palena, Miguel Montero-Baker, Robert Beasley, Jihad A. Mustapha, Luis R. Leon, Craig M. Walker, Aravinda Nanjundappa, Andrej Schmidt, Nelson L. Bernardo |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Population Vascular access 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Ischemia medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies 030212 general & internal medicine education Aged Retrospective Studies Aged 80 and over Leg education.field_of_study business.industry Mean age Arteries Critical limb ischemia Artery occlusions Middle Aged Limb Salvage Surgery Treatment Outcome Chronic Disease Retrograde approach Female Observational study medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Endovascular Therapy. 23:839-846 |
| ISSN: | 1545-1550 1526-6028 |
| DOI: | 10.1177/1526602816664768 |
| Popis: | Purpose: To report a prospective, multicenter, observational study ( ClinicalTrials.gov identifier NCT01609621) of the safety and effectiveness of tibiopedal access and retrograde crossing in the treatment of infrainguinal chronic total occlusions (CTOs). Methods: Twelve sites around the world prospectively enrolled 197 patients (mean age 71±11 years, range 41-93; 129 men) from May 2012 to July 2013 who met the inclusion criterion of at least one CTO for which a retrograde crossing procedure was planned or became necessary. The population consisted of 64 (32.5%) claudicants (Rutherford categories 2/3) and 133 (67.5%) patients with critical limb ischemia (Rutherford category ≥4). A primary antegrade attempt to cross had been made prior to the tibiopedal attempt in 132 (67.0%) cases. Techniques used for access, retrograde lesion crossing, and treatment were at the operator’s discretion. Follow-up data were obtained 30 days after the procedure. Results: Technical tibiopedal access success was achieved in 184 (93.4%) of 197 patients and technical occlusion crossing success in 157 (85.3%) of the 184 successful tibial accesses. Failed access attempts were more common in women (9 of 13 failures). The rate of successful crossing was roughly equivalent between sexes [84.7% (50/59) women compared to 85.6% (107/125) men]. Technical success did not differ significantly based on a prior failed antegrade attempt: the access success rate was 92.4% (122/132) after a failed antegrade access vs 95.4% (62/65) in those with a primary tibiopedal attempt (p=0.55). Similarly, crossing success was achieved in 82.8% (101/122) after a failed antegrade access vs 90.3% (56/62) for patients with no prior antegrade attempt (p=0.19). Minor complications related to the access site occurred in 11 (5.6%) cases; no patient had access vessel thrombosis, compartment syndrome, or surgical revascularization. Conclusion: Tibiopedal access appears to be safe and can be used effectively for the crossing of infrainguinal lesions in patients with severe lower limb ischemia. |
| Databáze: | OpenAIRE |
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