PMID- 32075489
OWN - NLM
STAT- MEDLINE
DCOM- 20200720
LR  - 20221207
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
VI  - 27
IP  - 2
DP  - 2020 Apr
TI  - Outcomes of Peripheral Vascular Interventions via Retrograde Pedal Access for 
      Chronic Limb-Threatening Ischemia in a Multicenter Registry.
PG  - 205-210
LID - 10.1177/1526602820908056 [doi]
AB  - Purpose: To describe the use and 1-year outcomes of retrograde pedal access 
      during peripheral vascular interventions (PVI) for chronic limb-threatening 
      ischemia (CLTI). Materials and Methods: From October 2016 to September 2017, 159 
      patients (mean age 71+/-10 years; 112 men) undergoing PVI via retrograde pedal 
      access were enrolled in the multicenter Vascular Quality Initiative (VQI) 
      registry. The pedal access approach included retrograde femoral (40%), antegrade 
      femoral (26%), retrograde to antegrade femoral (22%), and pedal only (11%). A 
      comparator group of 1972 patients (mean age 69+/-12 years; 1129 men) having a 
      contralateral retrograde femoral access was established for propensity matching, 
      which resulted in 156 patients per group. Procedure characteristics, technical 
      success, and access site complications were compared. Major adverse limb events 
      (MALE) and amputation-free survival (AFS) at 1 year were analyzed using the 
      Kaplan-Meier method and Cox proportional hazard models to calculate hazard ratios 
      (HR) and 95% confidence intervals (CI). Results: Technical failure was similar 
      for retrograde femoral and pedal access (7% vs 13%, p=0.07). Complications were 
      rare and included access site hematoma (2 vs 5, p=0.32) and target artery 
      thrombosis (0 vs 2) for the femoral vs pedal access groups, respectively. The 
      rates of MALE at 1 year were significantly lower after retrograde femoral access 
      (24%) compared with pedal access (38%; log-rank p=0.01; HR 1.95, 95% CI 1.15 to 
      3.30). AFS estimates at 1 year were similar: 86% for retrograde femoral and 83% 
      for pedal access (log-rank p=0.37; HR 1.32, 95% CI 0.73 to 2.39), as were major 
      amputation estimates: 10% for retrograde femoral access and 13% for pedal access 
      group (log-rank p=0.21; HR 1.58, 95% CI 0.77 to 3.26). Conclusion: In this 
      analysis of multicenter registry data, retrograde pedal access in patients with 
      CLTI had similar technical success and early complications in comparison with 
      traditional contralateral retrograde femoral access. The rates of MALE were 
      higher after pedal access but AFS was similar, indicating a tradeoff between limb 
      salvage and repeat interventions.
FAU - Perry, Mark
AU  - Perry M
AD  - University of Vermont Medical Center, Burlington, VT, USA.
FAU - Callas, Peter W
AU  - Callas PW
AD  - University of Vermont College of Medicine, Burlington, VT, USA.
FAU - Alef, Matthew J
AU  - Alef MJ
AD  - University of Vermont Medical Center, Burlington, VT, USA.
FAU - Bertges, Daniel J
AU  - Bertges DJ
AUID- ORCID: 0000-0002-9062-2326
AD  - University of Vermont Medical Center, Burlington, VT, USA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20200219
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Amputation, Surgical
MH  - Chronic Disease
MH  - *Endovascular Procedures/adverse effects
MH  - Female
MH  - Humans
MH  - Ischemia/diagnostic imaging/physiopathology/*therapy
MH  - Limb Salvage
MH  - Lower Extremity/*blood supply
MH  - Male
MH  - Middle Aged
MH  - Peripheral Arterial Disease/diagnostic imaging/physiopathology/*therapy
MH  - Progression-Free Survival
MH  - Registries
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - United States
OTO - NOTNLM
OT  - amputation
OT  - chronic limb-threatening ischemia
OT  - limb salvage
OT  - pedal access
OT  - peripheral vascular intervention
OT  - registry
EDAT- 2020/02/23 06:00
MHDA- 2020/07/21 06:00
CRDT- 2020/02/21 06:00
PHST- 2020/02/23 06:00 [pubmed]
PHST- 2020/07/21 06:00 [medline]
PHST- 2020/02/21 06:00 [entrez]
AID - 10.1177/1526602820908056 [doi]
PST - ppublish
SO  - J Endovasc Ther. 2020 Apr;27(2):205-210. doi: 10.1177/1526602820908056. Epub 2020 
      Feb 19.