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Approach to Tibiopedal Retrograde Revascularization of Below-The-Knee Peripheral Arterial Diseases With or Without Transradial Guidance Peripheral Angiography.
- Source :
-
The Journal of invasive cardiology [J Invasive Cardiol] 2020 Jan; Vol. 32 (1), pp. 6-11. - Publication Year :
- 2020
-
Abstract
- Objective: We sought to compare the use of transradial peripheral angiography to guide retrograde revascularization of below-the-knee (BTK) lesions using tibiopedal access (TPA).<br />Background: Tibiopedal retrograde revascularization of BTK lesions is an emerging technique in peripheral interventions.<br />Methods: We performed an observational cohort study of 194 consecutive adult patients with critical limb ischemia (CLI) who underwent endovascular intervention for BTK diseases using peripheral angiography and primary TPA access with vs without transradial (TR) guidance at 2 centers (New York, USA and Budapest, Hungary). The primary endpoints were procedure success, 30-day major adverse event rate, 30-day access-site complication rate, and 30-day access-site patency rate by ultrasound. Secondary endpoints were periprocedural complications, fluoroscopy time, procedure length, and crossover rate to femoral access.<br />Results: There were 78 patients in the TR-guidance group and 116 patients in the non-TR guidance group. Overall procedure success rates with TR guidance vs without TR guidance were 97% and 98%, respectively. Fluoroscopy times (732.8 ± 615.7 seconds vs 769.8 ± 565.8 seconds; P=NS) and procedure times (46.5 ± 24.4 minutes vs 55.4 ± 12.6 minutes; P=NS) were similar in the TR-guidance group vs the non-TR guidance group, but contrast volumes were higher in the TR-guidance group (100.0 ± 60.1 mL vs 43.8 ± 10.2 mL in the non-TR guidance group; P<.05). There was no difference in 30-day major adverse events, other than higher amputation rate in the TR-guidance group (15.3%), which was attributed to severe baseline complex CLI status in this patient group. There was 1 case of arteriovenous fistula, 1 case of pseudoaneurysm, and 1 case of tibiopedal artery occlusion at 30 days in the group without TR guidance. There were 3 cases (3.8%) of radial artery occlusion in the TR-guidance group.<br />Conclusions: The treatment of CLI with BTK lesions is feasible and safe, with a high procedural success rate and low access-site complication rate using the TPA approach regardless of whether or not TR guidance is utilized.
- Subjects :
- Aged
Female
Humans
Hungary
Lower Extremity blood supply
Lower Extremity surgery
Male
Outcome and Process Assessment, Health Care
Postoperative Complications diagnosis
Postoperative Complications prevention & control
Radial Artery surgery
United States
Vascular Patency
Angiography methods
Catheterization, Peripheral adverse effects
Catheterization, Peripheral methods
Endovascular Procedures adverse effects
Endovascular Procedures methods
Ischemia diagnosis
Ischemia etiology
Ischemia surgery
Peripheral Arterial Disease complications
Peripheral Arterial Disease diagnosis
Peripheral Arterial Disease surgery
Tibial Arteries surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1557-2501
- Volume :
- 32
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Journal of invasive cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 31893502