Retrograde transtibial technique as an alternative to the antegrade approach for the treatment of chronic lower-limb ischemia

Background Patients with complete occlusive lesions of the infrainguinal, and more frequently infragenicular, arteries have comorbid diseases that favor the endovascular option for treatment. In those patients the retrograde transtibial approach is suggested when the antegrade approach fails. This study aimed to describe the feasibility and complications of this approach. Patients and methods The retrograde transtibial approach was used, after a failed trial with the antegrade approach, in 29 patients suffering from severe chronic lower-limb ischemia. Success in accessing the tibial arteries, crossing the lesion, effectively dilating the occluded lesions, patency up to 6 months, and complication rate were measured. Results In all patients one of the tibial arteries was successfully accessed and the lesion was crossed. Postdilatation contrast study confirmed successful dilatation, which was maintained for 6 months, with no significant complications. Conclusion The retrograde transtibial approach is a feasible and safe alternative in treating infrainguinal arterial lesions when the antegrade approach fails or cannot be used.