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Peer-reviewedCC BYCVIR endovascular

Retrograde access revascularization in chronic limb threatening ischaemia.

  • Yujia Gao1
  • Lorenzo Patrone2
  • Neil Davies3
  • Anthie Papadopoulou3
  • Nick Woodward3
  • Janice Tsui1,4
  • Mark Portou4
  • Shanka Benaragama4
  • Conrad von Stempel5,6
6 affiliations
  1. 1Division of Surgery and Interventional Science, UCL Medical School, University College London, London, UK.
  2. 2Department of Surgery, Vascular and Endovascular Surgery Unit, USL Toscana Centro, San Giovanni Di Dio Hospital, Florence, Italy.
  3. 3Department of Radiology, Royal Free Hospital, London, UK.
  4. 4Department of Vascular Surgery, Royal Free Hospital, London, UK.
  5. 5Division of Surgery and Interventional Science, UCL Medical School, University College London, London, UK. [email protected].
  6. 6Department of Radiology, Royal Free Hospital, London, UK. [email protected].
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Abstract

Purpose

Chronic limb-threatening ischaemia (CLTI) is associated with high rates of major amputation, mortality and comorbidity that can make conventional femoral access challenging or contraindicated; in particular in patients with recent groin surgery, infection, previous aorto-bifemoral stent reconstruction, hostile groins, or unfavourable body habitus. Tibio-pedal arterial minimally invasive retrograde revascularisation (TAMI) provides an alternative access strategy.Materials and methods

This retrospective single-centre cohort study included 84 TAMI procedures in 81 limbs from 77 patients with CLTI (median age 72 years; 64% male; Rutherford IV 22%; Rutherford V-VI 78%). TAMI was performed because of recent groin surgery/infection in 35% of procedures and patient-related factors in 65%. The primary clinical endpoint was freedom from major adverse limb events (MALE), defined as major amputation or clinically driven target-vessel reintervention (CDTVR). Secondary endpoints included technical success, defined as restoration of continuous inline flow through at least one infrapopliteal artery to the foot with < 50% residual stenosis on completion angiography, and access vessel safety.Results

Retrograde access was obtained predominantly via the dorsalis pedis (71%) and distal posterior tibial arteries (16%). Technical success was achieved in 66/84 procedures (78%); in 10/84 (12%), TAMI access and lesion crossing were successful but the predefined angiographic endpoint was not met, while eight procedures (10%) were abandoned. Asymptomatic access vessel spasm was documented in 35/84 procedures (42%) that had resolved by 24 h. Among 68 patients (71 limbs) with longitudinal follow-up, median follow-up was 150 days (IQR 76-322). CDTVR occurred in 22/71 limbs (30%) and major amputation in 14/71 (20%); 25/68 patients (37%) died. Kaplan-Meier estimated freedom from MALE was 57.9% (95% CI 43.9-69.6%) at 6 months and 51.2% (95% CI 36.0-64.5%) at 12 months. In multivariable Cox regression analysis, none of the evaluated covariates was significantly associated with MALE.Conclusion

In this selected, anatomically complex CLTI cohort, TAMI was a feasible alternative access strategy when conventional femoral access was challenging or not feasible, with a low observed rate of clinically significant pedal access complications.

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Cite

BibTeXRIS
BibTeX
@article{gao2026retrograde,
  title = {{Retrograde access revascularization in chronic limb threatening ischaemia.}},
  author = {Yujia Gao and Lorenzo Patrone and Neil Davies and Anthie Papadopoulou and Nick Woodward and Janice Tsui and Mark Portou and Shanka Benaragama and Conrad von Stempel},
  journal = {CVIR endovascular},
  year = {2026},
  month = oct,
  doi = {10.1186/s42155-026-00786-5},
  url = {https://europepmc.org/article/MED/42873349},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Retrograde access revascularization in chronic limb threatening ischaemia.
AU  - Yujia Gao
AU  - Lorenzo Patrone
AU  - Neil Davies
AU  - Anthie Papadopoulou
AU  - Nick Woodward
AU  - Janice Tsui
AU  - Mark Portou
AU  - Shanka Benaragama
AU  - Conrad von Stempel
PY  - 2026
DA  - 2026/10/14
JO  - CVIR endovascular
DO  - 10.1186/s42155-026-00786-5
UR  - https://europepmc.org/article/MED/42873349
AB  - Purpose  Chronic limb-threatening ischaemia (CLTI) is associated with high rates of major amputation, mortality and comorbidity that can make conventional femoral access challenging or contraindicated; in particular in patients with recent groin surgery, infection, previous aorto-bifemoral stent reconstruction, hostile groins, or unfavourable body habitus. Tibio-pedal arterial minimally invasive retrograde revascularisation (TAMI) provides an alternative access strategy.Materials and methods  This retrospective single-centre cohort study included 84 TAMI procedures in 81 limbs from 77 patients with CLTI (median age 72 years; 64% male; Rutherford IV 22%; Rutherford V-VI 78%). TAMI was performed because of recent groin surgery/infection in 35% of procedures and patient-related factors in 65%. The primary clinical endpoint was freedom from major adverse limb events (MALE), defined as major amputation or clinically driven target-vessel reintervention (CDTVR). Secondary endpoints included technical success, defined as restoration of continuous inline flow through at least one infrapopliteal artery to the foot with < 50% residual stenosis on completion angiography, and access vessel safety.Results  Retrograde access was obtained predominantly via the dorsalis pedis (71%) and distal posterior tibial arteries (16%). Technical success was achieved in 66/84 procedures (78%); in 10/84 (12%), TAMI access and lesion crossing were successful but the predefined angiographic endpoint was not met, while eight procedures (10%) were abandoned. Asymptomatic access vessel spasm was documented in 35/84 procedures (42%) that had resolved by 24 h. Among 68 patients (71 limbs) with longitudinal follow-up, median follow-up was 150 days (IQR 76-322). CDTVR occurred in 22/71 limbs (30%) and major amputation in 14/71 (20%); 25/68 patients (37%) died. Kaplan-Meier estimated freedom from MALE was 57.9% (95% CI 43.9-69.6%) at 6 months and 51.2% (95% CI 36.0-64.5%) at 12 months. In multivariable Cox regression analysis, none of the evaluated covariates was significantly associated with MALE.Conclusion  In this selected, anatomically complex CLTI cohort, TAMI was a feasible alternative access strategy when conventional femoral access was challenging or not feasible, with a low observed rate of clinically significant pedal access complications.
SN  - 2520-8934
ER  -