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Year : 2018  |  Volume : 37  |  Issue : 1  |  Page : 60-67

Retrograde approach for complex lower limb arterial occlusions

Vascular Surgery Department, Mansoura University, Mansoura, Egypt

Correspondence Address:
Ahmed Elmetwally
Vascular Surgery Department, Mansoura University Hospital, Mansoura University, Algomhoria Street, Mansoura, 35511
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejs.ejs_104_17

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Introduction Despite the advancement of endovascular technology, there are complex lesions which cannot be passed through antegrade approach, a retrograde approach to cross the complex lesion was first described by Iyer and colleagues, and it was used in cases where antegrade approach failed to cross the lesion. This promising technique had good results and was done through surgical incision and direct arterial puncture. Patients and methods A registry of retrograde approach has been maintained since March 2014, when the first transposterior tibial retrograde recanalization was performed at our institution till March 2016. Thirty-six patients were selected from the registry with age range from 49 to 85 (65.14), male pateints were 21 (58.3%) and female patients were 15 (41.7%). Patients were Rutherford class 4 (six patients), 5 (21 patients) and 6 (nine patients). Results After retrograde angioplasty a Kaplan–Meier curve for patency was 77.7% (28 of 36), 63.8% (23 of 36) and 47.2% (17 of 36) at 6, 12 and 24 months, respectively. Limb salvage rates were 97.2, 80.6, and 66.4% at 6, 12, and 24 months, respectively. Conclusion Retrograde approach is a safe and effective way to pass a complex lesion and it provides an alternative way to surgery with less complications and faster recovery.

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