Mid-term results of endovascular revascularization through primary retrograde distal access

Platonov SA, Zhigalo VN, Mkrtchyan GV, et al. . Mid-term results of endovascular revascularization through primary retrograde distal access. Pirogov Russian Journal of Surgery. 2024;(12):44‑51. (In Russ., In Engl.)
https://doi.org/10.17116/hirurgia202412144

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

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OBJECTIVE

To evaluate the mid-term results of endovascular revascularization of the lower extremities through primary retrograde distal approach.

MATERIAL AND METHODS

We prospectively analyzed the mid-term results of 74 endovascular surgeries via primary retrograde distal approach in 69 patients with lower extremity ischemia. Mean age of patients was 68.6±8.9 years. Men prevailed (66.2%); 50% of patients suffered from diabetes mellitus. In 70.3% of cases, the indication for intervention was ischemic ulcerative-necrotic defects of the foot. Revascularization through anterior tibial artery was the most common (63.5%). Angiosomal artery was catheterized in 59.6% of cases; the only patent lower leg vessel — in 25.7% of cases. Antegrade recanalization of “adjacent” tibial artery via distal approach was performed in 40.5% of cases.

RESULTS

Distal access was successful in all cases. Retrograde revascularization (restoration of blood flow to the foot through at least one tibial artery) was successful in 91.9% of cases. Conversion to antegrade intervention was necessary in 8.1% of cases. Recanalization of adjacent tibial artery was successful in 100% of cases. Direct revascularization of the affected angiosome was performed in 76.9% of patients with foot tissue necrosis, indirect revascularization through collaterals — in 23.1% of cases. Access-related morbidity was 8.1%, all complications were local in nature. Most of them (83.3%) regressed without loss of arterial patency. Freedom from limb amputation and thrombosis of access-related artery within two years was 87.0% and 88.1%, respectively. Occlusion of access-related artery immediately before amputation was observed only in 1 case.

CONCLUSION

Endovascular revascularization through primary retrograde distal access is effective and safe. Freedom from limb amputation and thrombosis of access-related artery within two years is high.

Keywords:

primary retrograde distal access

lower limb ischemia

Authors:

Platonov S.A.

Dzhanelidze Research Institute for Emergency Care

ORCID: 0000-0001-5521-7467

Zhigalo V.N.

Dzhanelidze Research Institute for Emergency Care

ORCID: 0000-0002-8270-9114

Mkrtchyan G.V.

Dzhanelidze Research Institute for Emergency Care

ORCID: 0009-0007-9827-1499

Kuryanov P.S.

St. George’s Hospital

ORCID: 0000-0001-5844-2547

Fomin K.N.

Dzhanelidze Research Institute for Emergency Care

ORCID: 0000-0002-9020-5629

Isaev K.Sh.

Dzhanelidze Research Institute for Emergency Care

ORCID: 0000-0003-4418-0333

Zavatsky V.V.

Aleksandrovskaya Hospital

ORCID: 0000-0002-9970-0415

Kandyba D.V.

Dzhanelidze Research Institute for Emergency Care

ORCID: 0000-0002-9715-5505

Dudanov I.P.

Petrozavodsk State University

ORCID: 0000-0002-0629-6581

Received:

22.08.2024

Accepted:

04.09.2024

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