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Tibiopedal access in patients with lower limb peripheral artery disease

Yavor Kyumyurdzhiyski, Kolyo Karahristov, Chavdar Bachvarov, Georgi Todorov


Introduction: Peripheral artery disease (also known as PAD) is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. Atherosclerotic vascular disease affecting the lower extremities is the most common form of peripheral vascular disease. Patients with critical limb ischemia have significant rates of amputation. However, percutaneous options for minimally in­vasive revascularization exist for most of these patients. In recent years, the retrograde tibiopedal ap­proach is increasingly being used for revascularization of complex chronic total occlusions.

Methods and materials: In cases where traditional ipsilateral antegrade or contralateral cross over approaches fail, pedal access approaches utilizing the dorsalis pedis, posterior tibial, or even pero­neal arteries (most difficult of the three) have been used. The technique is performed by ultrasound guidance using arterial introducers, hydrophilic wires and vasodilators which allow for better access and easier manipulation.

Results: In this particular study from a total of 39 cases, a total of 34 cases (87,2%) were successful. Access through ATA was used in 26 of the patients and through PTA in 6 patients. Recanalization of total occlusions was achieved in 14 cases.

Conclusion: Preventing amputations can potentially save patient lives and improve quality of life. Tibiopedal access has emerged as an important tool to facilitate successful revascularizations. One of the major advantages of retrograde tibiopedal access is that it allows quick therapy and short pro­cedure time with less observation time in the hospital. The procedure can be used as a viable alterna­tive to antegrade access interventions. Further well-conducted studies are crucial in generating more high-quality evidence in the field of critical limb ischemia management.


radiology; interventional radiology; endovascular treatment



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