Primary Retrograde Dorsalis Pedis Artery Single Access For Revascularization of Chronic Total Occlusion in Patients with Critical Limb Ischemia

Daniel Raskin 1 Boris Khaitovich 1 Daniel Silverberg 2 Moshe Halak 2 Uri Rimon 1
1Diagnostic Imaging, Sackler School of Medicine, Tel-Aviv University, Israel
2Vascular Surgery, Sackler School of Medicine, Tel-Aviv University, Israel

PURPOSE: To evaluate the Dorsalis Pedis artery (DPA) approach as a single access for revascularization in patients with critical limb ischemia (CLI) when femoral approach is unfavorable.

MATERIALS AND METHODS: A retrospective review of patients who underwent supra- and infrainguinal ipsilateral revascularization via a single access from the DPA between January 2017 until and February 2018 was performed. Fifteen limbs in 15 patients, 10 men and 5 women, average age 72 years (range 49-96 years) with CLI and unfavorable femoral access. Treated limbs were classified as Rutherford category 5 and 6 in 12 patients and class 4 in 3 patients. The treated occluded segments involved 2 suprainguinal arteries, 12 femoropopliteal arteries and 1 bypass. Technical success was defined as recanalization of the occluded artery with residual stenosis less than 30%, and improvement in ABI after 24 hours. Patients were followed up for up to 13 months. The end points were freedom from reintervention and limb salvage for one year.

RESULTS: Technical success was achieved in 14 of the 15 patients (93%). Stents were placed in 13 of 15 patients (86%). No immediate post procedural complications were encountered. Median follow-up was 7.1 months (range 1.4-13.5). One patient was lost on follow-up. Reintervention was needed in 5 limbs after an average of 4.2 months. Limb salvage was achieved in all followed up patients but one.

CONCLUSION: Using the DPA as a single access could be a valuable approach when traditional access sites are unfavorable for treating patients with CLI.

Daniel Raskin
Daniel Raskin