Study Supports Tibiopedal Access for Crossing of Infrainguinal Artery Occlusions


December 1, 2016—A prospective, multicenter, observational study evaluated the safety and effectiveness of tibiopedal access and retrograde crossing in the treatment of infrainguinal chronic total occlusions (CTOs). The study demonstrated that tibiopedal access appears to be safe and can be used effectively for the crossing of infrainguinal lesions in patients with severe lower limb ischemia. Craig M. Walker, MD, et al published the study's findings in the Journal of Endovascular Therapy (JEVT; 2016;23:839–846).

The study was conducted at 12 sites around the world from May 2012 to July 2013. Investigators prospectively enrolled 197 patients (mean age, 71 ± 11 years; range, 41–93 years; 129 men) who met the inclusion criterion of at least one CTO for which a retrograde crossing procedure was planned or became necessary. The study population was composed of 64 (32.5%) claudicants (Rutherford categories 2/3) and 133 (67.5%) patients with critical limb ischemia (Rutherford category ≥ 4).

The investigators noted that a primary antegrade attempt to cross the lesion had been made before the tibiopedal attempt in 132 (67%) 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.

As summarized in the JEVT, technical tibiopedal access success was achieved in 184 of 197 (93.4%) patients, and technical occlusion crossing success was achieved in 157 of the 184 (85.3%) tibial accesses. Failed access attempts were more common in women (9 of 13 failures). The rate of successful crossing was approximately equivalent between sexes (84.7% [50/59] women compared to 85.6% [107/125] men).

Additionally, the investigators found that technical success did not significantly differ based on a previous failed antegrade attempt; the access success rate was 92.4% (122/132) after a failed antegrade access versus 95.4% (62/65) in those with a primary tibiopedal attempt (P = .55). Similarly, crossing success was achieved in 82.8% (101/122) after a failed antegrade access versus 90.3% (56/62) for patients with no previous antegrade attempt (P = .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, reported the investigators in JEVT.


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