Long-Term Outcomes of Successful Endovascular Therapy Via the Retrograde Approach for Below-the-Knee Chronic Total Occlusion in Patients With Critical Limb Ischemia After a Failed Antegrade Approach

This study evaluated long-term results following successful endovascular therapy (EVT) for chronic total occlusion (CTO) below the knee (BTK) using the retrograde approach after a failed antegrade approach.Nineteen patients (19 limbs) with critical limb ischemia (CLI) who underwent successful EVT for BTK-CTO using the retrograde approach after a failed antegrade approach during 2010-2014 were studied.Mean duration of the follow-up period was 25.5 ± 17.9 months, and mean age was 76.0 ± 8.6 years. Patients on hemodialysis accounted for 10 cases (52.6%). Patients with Rutherford class 4 constituted 3 cases (15.8%) , while 8 patients each (42.1%) were categorized as Rutherford class 5 and class 6, respectively. All lesions were de novo CTOs. The mean occlusion length was 203.7 ± 114.7 mm. Vascular access for the retrograde approach was obtained via distal puncture in 9 cases (47.4%), whereas the transcollateral approach was employed in 10 cases (52.6%). The amputation-free survival rates at 1, 2, 3, 4, and 5 years after the index procedure were 78.6%, 66.9%, 66.9%, 50.2%, and 50.2%, respectively.Successful EVT for BTK-CTO using various techniques via the retrograde approach provides promising long-term results in patients with CLI.