Abstract
Introduction. According to the literature, about 90% of patients with a clinical picture of intermittent claudication have multilevel lesions of the peripheral arteries. Half of these patients have complex occlusive lesions that require
optimal revascularization tactics.
Material and methods. At the Far East Federal University Medical Center from January 2016 to December 2019, 272 peripheral angioplasty of lower extremities arteries were performed. Occlusive lesions were revealed in 48.5%
(n = 132) patients. Femoral artery was used in these patients as a primary surgical access, with an attempt to conduct antegrade angioplasty. In case of unsuccessful antegrade angioplasty, same access was used to perform the retrograde recanalization through the collaterals. When both of the approaches were unsuccessful, the distal arterial access was performed.
Results. Of 132 patients with occlusive lesions, peripheral angioplasty was performed using the antegrade recanalization in 79.5% (n = 105) of patients, retrograde recanalization – in 4.5% (n = 6) of patients, retrograde recanalization with distal artery access – in 15.9% (n = 21) of patients. The applied strategy of a stepwise use of angioplasty methods allowed us to achieve the 100% rate of artery recanalization. A comparative assessment of angioplasty techniques showed that distal angioplasty has a greater number of complications due to higher rate of arteriosection.
Conclusion. Retrograde recanalization from the femoral access is an effective method of revascularization in patients with chronic lower limb arteries occlusion. Femoral access can be used to perform retrograde recanalization through the collaterals, supplying the distal bed of the affected artery, that has diameter of at least 1 mm and no severe tortuosity. The method of retrograde recanalization from the proximal femoral approach is preferred over distal access in patients with obliterating atherosclerosis in case of suitable blood vessel anatomy.
References
- Yasuhiro Takahashi, Taisuke Sato, Hirotake Okazaki, Ayaka Nozaki, Masato Matsushita, Masataka Kamiya, Wataru Shimizu. Transvenous intravascular ultrasound – guided endovascular treatment for chronic total occlusion of the infrainguinal arteries. J. Endovasc. Ther. 2017; 24 (5): 718–26. DOI: 10.1177/1526602817723139
- Pokrovskiy A.V., Akchurin R.S., Alekyan B.G., Apkhanova T.V., Arakelyan V.S., Akhmedzhanov N.M. et al. National recommendations for the diagnosis and treatment of lower limb artery diseases. Moscow; 2019: 55–62 (in Russ.).
- Stepanov E.V., Selyutin S.M., Vasil'ev V.A., Levitskiy A.A., Shchava S.P., Sorokin V.A. Comparative evaluation of the effectiveness of retrograde recanalization of the lower leg arteries using femoral access. The Bulletin of Bakoulev Journal. Cardiovascular Diseases. 2019; 20 (11, appl.): 142 (in Russ.).
- National guidelines. X-ray vascular surgery. Ed. academician B.G. Alekyan. Moscow; 2017: 9–32 (in Russ.).
- Kavteladze Z.A., Bylov K.V., Drozdov S.A. Retrograde recanalization of the lower leg arteries. In: Theses of the Fourth Russian Congress of Interventional Cardioangiologists. Moscow; 2011: 54–6 (in Russ.).
- Bozlar U., Ming-Chen P.Sh., Harthun N.L., Hagspielм K.D. Outback catheter-assisted simultaneous antegrade and retrograde access for subintimal recanalization of peripheral arterial occlusion. Clin. Imaging. 2008; 32 (3): 236–40. DOI: 10.1016/j.clinimag.2007.09.014
- Brountzos E.N., Moulakakis K.G., Avgerinos E.D., Dalainas I.G., Giannakopoulos T., Kakisis J. et al. Retrograde transpopliteal approach of iliofemoral lesions. Endovasc. Surg. 2011; 45 (7): 646–50. DOI: 10.1177/1538574411414308
- Rapovka V.G., Sorokin V.A., Cherkashin A.Ya. Complex treatment of critical lower limb ischemia. Angiology and Vascular Surgery. Vladivostok; 1997: 77–8 (in Russ.).
- Conte M.S., Bradbury A.W., Kolh Ph., White J.V., Dick F., Fitridge R. et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur. J. Vasc. Endovasc. Surg. 2019; S1–S109.e33. DOI: 10.1016/j.ejvs.2019.05.006
- Pokrovskiy A.V. Clinical angiology. Practical guide; in 2 volumes. Moscow; 2004: 2: 184–94 (in Russ.).
- Sanghvi K.A., Kusick J., Krathen C. Retrograde tibiopedal access for revascularization of lower-extremity peripheral artery disease using a 6 Fr slender sheath: The "Pedal-First" Pilot Project. J. Invasive Cardiol. 2018; 30 (9): 334–40. DOI: 10.1016/j.jacc.2017.09.999
- Graziani L., Silvestro A., Bertone V., Manara E., Andreini R., Sigala A. et al. Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. Eur. J. Vasc. Endovasc. Surg. 2007; 33: 4: 453–60. DOI: 10.1016/j.ejvs.2006.11.022
About the authors
- Evgeniy V. Stepanov, Physician of Endovascular Diagnostics and Treatment,
ORCID
- Sergey M. Selyutin, Endovascular Diagnostic and Treatment, ORCID
- Vladislav A. Vasil'ev, Cand. Med. Sc., Cardiovascular Surgeon, ORCID
- Aleksandr A. Levitsky, Cardiovascular Surgeon, ORCID
- Nikita K. Klyshko, Cardiovascular Surgeon, ORCID
- Sergey P. Shchava, Cand. Med. Sc., Cardiovascular Surgeon, ORCID
- Vitaliy A. Sorokin, Dr. Med. Sc., Professor, Cardiovascular Surgeon,
ORCID
