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Peer-reviewedCC BY-NCTurk gogus kalp damar cerrahisi dergisi

Retrograde pedal access to facilitate intraluminal recanalization in complex infrainguinal chronic total occlusions.

  • Selim Aydın1
  • Yakup Tire2
  • İbrahim Gökçe3
  • Bahar Temur4
  • Emre Özker5
  • Ersin Erek1
5 affiliations
  1. 1Department of Cardiovascular Surgery, Acıbadem University Faculty of Medicine, İstanbul, Türkiye.
  2. 2Department of Cardiovascular Surgery, Acıbadem University Atakent Hospital, İstanbul, Türkiye.
  3. 3Acıbadem University Faculty of Medicine, İstanbul, Türkiye.
  4. 4Clinic of Cardiovascular Surgery, Medicana Çamlıca Hospital, İstanbul, Türkiye.
  5. 5Clinic of Cardiovascular Surgery, Acıbadem Altunizade Hospital, İstanbul, Türkiye.
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Abstract

Background

This study aimed to assess the feasibility, safety, and clinical performance of retrograde pedal access to facilitate intraluminal crossing in complex infrainguinal chronic total occlusions in patients with advanced peripheral artery disease.Methods

In this retrospective, single-centre analysis, 33 patients undergoing endovascular revascularization for complex peripheral arterial chronic total occlusions between August 2021 and October 2024 were evaluated. Retrograde pedal access was performed when intraluminal crossing could not be achieved using antegrade or contralateral femoral approaches. The primary endpoint was technical success, defined as successful intraluminal crossing. Secondary endpoints included procedural complications, freedom from clinically driven target lesion revascularisation, longitudinal changes in Rutherford classification, wound healing, limb salvage and all-cause mortality.Results

Successful intraluminal crossing via retrograde pedal access was achieved in 30 patients (90.9%). The posterior tibial artery (39.4%) and anterior tibial artery (36.4%) were the most commonly utilized access sites. Among the 30 patients who underwent definitive endovascular treatment after successful intraluminal crossing, the most frequent complication was flow-limiting dissection, occurring in five patients (16.7%); no cases of perforation, distal embolization, pseudoaneurysm, arteriovenous fistula, or procedure-related death were recorded. Kaplan-Meier estimated freedom from clinically driven target lesion revascularization was 96.7% at 12 months and 75.5% at 24 months. No major amputations occurred, and all patients presenting with tissue loss achieved complete wound healing, with or without minor amputation.Conclusion

Retrograde pedal access represents a safe and effective approach for achieving intraluminal crossing in complex peripheral chronic total occlusions, particularly among patients with chronic limb-threatening ischemia. The high rate of technical success and favorable limb-related outcomes support its role as an integral component of modern endovascular revascularization strategies.

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Cite

BibTeXRIS
BibTeX
@article{aydın2026retrograde,
  title = {{Retrograde pedal access to facilitate intraluminal recanalization in complex infrainguinal chronic total occlusions.}},
  author = {Selim Aydın and Yakup Tire and İbrahim Gökçe and Bahar Temur and Emre Özker and Ersin Erek},
  journal = {Turk gogus kalp damar cerrahisi dergisi},
  year = {2026},
  month = oct,
  doi = {10.4274/tjtcs.2026.2026-4-22},
  url = {https://europepmc.org/article/MED/42840081},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Retrograde pedal access to facilitate intraluminal recanalization in complex infrainguinal chronic total occlusions.
AU  - Selim Aydın
AU  - Yakup Tire
AU  - İbrahim Gökçe
AU  - Bahar Temur
AU  - Emre Özker
AU  - Ersin Erek
PY  - 2026
DA  - 2026/10/07
JO  - Turk gogus kalp damar cerrahisi dergisi
DO  - 10.4274/tjtcs.2026.2026-4-22
UR  - https://europepmc.org/article/MED/42840081
AB  - Background  This study aimed to assess the feasibility, safety, and clinical performance of retrograde pedal access to facilitate intraluminal crossing in complex infrainguinal chronic total occlusions in patients with advanced peripheral artery disease.Methods  In this retrospective, single-centre analysis, 33 patients undergoing endovascular revascularization for complex peripheral arterial chronic total occlusions between August 2021 and October 2024 were evaluated. Retrograde pedal access was performed when intraluminal crossing could not be achieved using antegrade or contralateral femoral approaches. The primary endpoint was technical success, defined as successful intraluminal crossing. Secondary endpoints included procedural complications, freedom from clinically driven target lesion revascularisation, longitudinal changes in Rutherford classification, wound healing, limb salvage and all-cause mortality.Results  Successful intraluminal crossing via retrograde pedal access was achieved in 30 patients (90.9%). The posterior tibial artery (39.4%) and anterior tibial artery (36.4%) were the most commonly utilized access sites. Among the 30 patients who underwent definitive endovascular treatment after successful intraluminal crossing, the most frequent complication was flow-limiting dissection, occurring in five patients (16.7%); no cases of perforation, distal embolization, pseudoaneurysm, arteriovenous fistula, or procedure-related death were recorded. Kaplan-Meier estimated freedom from clinically driven target lesion revascularization was 96.7% at 12 months and 75.5% at 24 months. No major amputations occurred, and all patients presenting with tissue loss achieved complete wound healing, with or without minor amputation.Conclusion  Retrograde pedal access represents a safe and effective approach for achieving intraluminal crossing in complex peripheral chronic total occlusions, particularly among patients with chronic limb-threatening ischemia. The high rate of technical success and favorable limb-related outcomes support its role as an integral component of modern endovascular revascularization strategies.
SN  - 1301-5680
SN  - 2149-8156
ER  -