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Case Reports
. 2024 Nov 27;20(2):1047-1052.
doi: 10.1016/j.radcr.2024.10.141. eCollection 2025 Feb.

Retrograde endovascular intervention treating chronic limb threatening ischemia: A case report

Tran Minh Bao Luan  1   2 , Nguyen Huu Tuong  3   2 , Tran Quoc Han  2
Affiliations
Case Reports

Retrograde endovascular intervention treating chronic limb threatening ischemia: A case report

Tran Minh Bao Luan et al. Radiol Case Rep. .

Abstract

The retrograde approach is an adjunctive technique for endovascular intervention, particularly in the treatment of lower extremity arterial disease with multilevel vascular lesions. Combined with revascularization therapy, wound care plays a pivotal role in the management of patients with chronic limb-threatening ischemia. We present a case of chronic limb-threatening ischemia, with complex multilevel vascular lesions successfully treated using a retrograde endovascular approach alongside aggressive wound care management. Postintervention, the patient demonstrated a notable increase in ankle-brachial index from 0 to 1, along with accelerated wound healing and preservation of limb function. This case highlights the efficacy of the retrograde approach in restoring perfusion, particularly in chronic total occlusions, and emphasizes the importance of combining revascularization and wound care for optimal chronic limb-threatening ischemia management.

Keywords: Chronic limb-threatening ischemia; Endovascular intervention; Peripheral vascular disease; Retrograde approach; Wound care.

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Figures

Fig 1
Fig. 1
(A) Right foot ulcer with WIfI (Wound, Ischemia, and foot Infection) stage 4 (W3 I3 fI 3). (B) Left foot ulcer with WIfI (Wound, Ischemia, and foot Infection) stage 3 (W1 I3 fI 3). (C) Computed tomography angiography of the lower extremity arteries.
Fig 2
Fig. 2
Lesions of the arterial system of the lower extremities on both sides, GLASS grade 3 for the FP level with moderate stenosis of the bilateral CIA, occlusion of the left EIA, occlusion of the bilateral CFA and SFA. Guiding the need for retrograde access.
Fig 3
Fig. 3
(A) Right PA access. (B) Angiography showing the patency of the right FP artery following intervention.
Fig 4
Fig. 4
(A) Left PA access. (B) Angiography showing the patency of the left SFA following intervention. (C) Angiography showing the patency of the left EIA, CFA following intervention.
Fig 5
Fig. 5
(A) Ulcer on the right foot postintervention at 1 month. (B) Right foot at 3 months. (C) Right foot at 1 year. (D) Ulcer on the left foot postintervention at 1 month. (E) Left foot at 3 months.
See this image and copyright information in PMC

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