Combined percutaneous direct puncture of occluded artery – antegrade intervention for recanalization of below the knee arteries

Abstract

PURPOSE We aimed to assess the technical success of the combined percutaneous direct puncture of occluded artery – antegrade intervention technique, as well as the clinical effectiveness of treatment, on the basis of changes in the Rutherford classification. METHODS Between June 2015 and July 2018, 441 patients underwent endovascular recanalization due to lower limb peripheral arterial disease at our center. Of these, 18 patients (4%; 15 males, 3 females; mean age, 63.2 years) had failed antegrade recanalization and percutaneous retrograde access because of long segment occlusion, arterial rupture or dissection. Combined percutaneous direct puncture of occluded artery and antegrade approach was applied to these patients. Clinical follow-up examinations were performed at 1 month, 3 months, 6 months, and annually thereafter. RESULTS The mean follow-up period was 22.8±10.9 months. The mean procedure time was 93.6±28.2 min. Technical success was achieved in 14 patients (78%). Complete restoration of arterial flow in the punctured vessel could not be achieved in 4 patients (22%). Minor complications occurred in 4 of 18 procedures (22%). Amputation-free survival and limb salvage rates (83.3% and 100%, respectively) were the same for 12 and 24 months. CONCLUSION Technical success in lower limb peripheral arterial disease may be improved with the use of a combined percutaneous direct puncture of occluded artery – antegrade intervention, particularly for patients in whom other techniques are not a viable option.