Pedal access in critical limb ischemia

Abstract

Interventional therapy of critical limb ischemia has developed into first-line therapy. Successful intervention is dependent on crossing obstructive lesions. Retrograde tibial access often allows successful crossing of lesions that can’t be crossed in antegrade manner. This increases the rate of successful interventional treatment of critical limb ischemia. Any interventionist can easily perform retrograde tibial approach without the need for specialized equipment. With careful attention, it can be performed with low risk of damage to the pedal vessels, which may serve as future bypass targets. Retrograde tibial access may also lessen the need for reentry tools in certain cases, which may serve to lessen cost. This chapter includes a simple 13-step process to achieve access and avoid complications.