Antegrade vs Crossover Femoral Artery Access in the Endovascular Treatment of Isolated Below-the-Knee Lesions in Patients With Critical Limb Ischemia.
| Title | Antegrade vs Crossover Femoral Artery Access in the Endovascular Treatment of Isolated Below-the-Knee Lesions in Patients With Critical Limb Ischemia. |
| Publication Type | Journal Article |
| Year of Publication | 2017 |
| Authors | Li, Y., Esmail A., Donas K. P., Pitoulias G., Torsello G., Bisdas T., Michelagnoli S., & Troisi N. |
| Journal | J Endovasc Ther |
| Volume | 24 |
| Issue | 3 |
| Pagination | 331-336 |
| Date Published | 2017 06 |
| ISSN | 1545-1550 |
| Keywords | Aged, Aged, 80 and over, Angioplasty, Balloon, Critical Illness, Disease-Free Survival, Female, Femoral Artery, Germany, Humans, Ischemia, Italy, Lower Extremity, Male, Middle Aged, Peripheral Arterial Disease, Punctures, Retrospective Studies, Risk Factors, Stents, Time Factors, Treatment Outcome, Vascular Patency |
| Abstract | PURPOSE: To evaluate the safety and effectiveness of antegrade vs crossover femoral artery access in the endovascular treatment of isolated below-the-knee (BTK) lesions in patients with critical limb ischemia (CLI).METHODS: Between January 2014 and December 2015, 224 high-risk patients (mean age 75.8±9.8 years; 151 men) with CLI underwent infragenicular interventions on 292 crural vessels in 3 European vascular centers. All patients had isolated TransAtlantic Inter-Society Consensus (TASC) C (n=26) or D (n=198) BTK lesions. Primary endpoints were freedom from access-related complications and technical success comparing the antegrade vs crossover access groups.RESULTS: Balloon angioplasty was the most used treatment modality (169 vessels, 75.4%). The technical success rate was 88.4% in the entire cohort and 88.0% in the antegrade group vs 90.4% in the crossover group (p>0.99). In all patients, the technical success rate was higher for stenotic lesions (100%) vs occlusions (85.5%, p=0.002) and in patients with TASC C BTK lesions (100%) vs TASC D (86.9%, p=0.033). The overall freedom from access-related complications was 97.8%: 99% in the antegrade group and 90.6% in the crossover group (p=0.022). Larger sheath size (5/6-F vs 4-F) was associated with a significantly higher risk for access-related complications (7.1% vs 1.1%, respectively; p=0.047).CONCLUSION: The present multicenter study showed high technical success and a low incidence of access-related complications in the treatment of isolated BTK lesions using either antegrade or crossover femoral access. The antegrade approach with the use of a 4-F system seems to have a significantly lower rate of access-related complications. |
| DOI | 10.1177/1526602817701251 |
| Alternate Journal | J. Endovasc. Ther. |
| PubMed ID | 28378609 |
