Outcomes of Retrograde Endovascular Interventions for Patients with Chronic Limb-threatening Ischemia

An alternative for patients who have failed antegrade endovascular intervention includes the use of retrograde access. This study examines the outcomes of patients with chronic limb-threatening ischemia (CLTI) who are not candidates for bypass who underwent unsuccessful antegrade access. A retrospective review was performed of all retrograde endovascular interventions performed from 2017 to 2022 at a single high-volume center. Data including patients’ demographics, comorbidities, indications, and procedural characteristics were recorded (Table). Outcomes analyzed were success rates, limb salvage rate, and postoperative complications. Forty-eight patients presenting with CTLI who failed anterograde revascularization underwent retrograde endovascular intervention. Of these, 24 patients (50%) underwent popliteal artery access. Twenty-one patients (44%) underwent tibial vessel access, and three patients (6%) underwent plantar artery access. Forty patients (83%) underwent successful retrograde intervention. Intervention failures were due to inability to cross the occlusion. A crosser device was used in 44 interventions (92%). Shorter lesion length demonstrated a trend for success (P = .081). At a mean follow up of 7.3 ± 8.0 months, the limb salvage rate was 85%. The procedural complication rate was 6%, with the most common complication being arterial dissection. The 30-day mortality for patients undergoing retrograde endovascular intervention was 4%. TransAtlantic InterSociety Consensus D classification was associated with a higher procedural failure (odds ratio, 2.3). Preoperative Rutherford classification was not associated with major amputation rates during follow-up (P > .05). Retrograde endovascular revascularization is a safe alternative achieving acceptable limb salvage rate in patients with CTLI who are not candidates for bypass and failed anterograde revascularization. Longer lesions were associated with lack of technical success.TableDemographics, comorbidities, and indications of 48 patientsVariableDataMean age, years71.83 ± 10.096Males62.5%Diabetes87.5%Hypertension83.3%Coronary artery disease52.1%Chronic kidney disease22.9%TASC B6.3%TASC C16.7%TASC D77%Rutherford class 410.4%Rutherford class 570.8%Rutherford class 618.8%TASC, TransAtlantic InterSociety Consensus. Open table in a new tab