Transpedal Approach in Failed Antegrade Attempt of Lower Limb Peripheral Arterial Disease-A Review with Different Treatment Strategies

Abstract

Transpedal access is an evolving technique primarily used in patients after failed femoral antegrade approach to revascularize complex tibiopedal lesions. In patients who are at high risk for surgery the transpedal access may be the only option in failed antegrade femoral access to avoid amputation of the limbs. In recent years transpedal access is used routinely to revascularize supra-popliteal lesions due to more success and less complications over femoral artery approach. Retrograde approach parse will not give success in all cases and importantly success depends on techniques used. There are different techniques that need to be used depending on lesion characteristics, comorbidities, and hardware available to improve success with less complications. This review provides different strategies for successful treatment of iliac and femoral artery lesions by transpedal approach after failed antegrade femoral attempt.

Keywords: critical limb ischemia; lower extremity; peripheral arterial disease; transpedal approach.

Fig. 1

Showing percutaneous angioplasty of patient no. 2. ( A ) Showing posterior tibial artery access with 6F sheath in-situ, ( B ) initial angiogram of access artery showing patent posterior tibial artery, ( C ) wire crossing the lesion with the help of 4F multipurpose catheter, ( D ) final angiogram after stenting showing good result with no complication.

Fig. 2

Showing percutaneous angioplasty of patient no. 6. ( A ) Crossing the lesion with 0.014″ wire with the help of coronary balloon support, ( B ) knuckle wire technique, ( C ) trapping of the retrograde wire with 3-mm balloon in antegrade catheter, ( D ) final angiogram showing good result with no complication.