Outcome of retrograde approach in management of chronic arterial occlusive disease of lower extremities

Abstract

Introduction

Peripheral arterial disease or chronic arterial occlusive disease of lower extremities is a common problem, and in the advanced stages of the disease, if not re-vascularized, the rate of amputation and mortality can be as high as 43 % and 25 % respectively. Many studies also show that the rate of successful revascularization with an antegrade approach has a failure rate of 10–20 %. Therefore, the retrograde intervention technique was developed to increase the success rate of revascularization.

Objectives

Morphological classification of lesions and results of retrograde approach in the treatment of chronic arterial occlusive disease in lower extremities.

Method

Retrospective descriptive study. Thirty-five patients with 39 limbs received intervention with the retrograde approach at the Department of Thoracic and Vascular Surgery, University Medical Center. Ho Chi Minh City from February 2017 to December 2021.

Results

Most of the patients had multiple risk factors, including hypertension, diabetes, high grade on the Rutherford scale (79.5 % with Rutherford 5), and diffuse vascular disease (89.8 % GLASS III). Recanalization was technically successful in 84.6 % (33/39) limbs, and the patients with limb preservation rate at 6 months after intervention 88.5 %. Results at 12 and 24 months also confirm the procedure's feasibility and positive outlook. The local complication rate was low 7.7 % (3/39). There was 1 case that died 3 weeks after the intervention, not directly related to the procedure.

Conclusion

The retrograde technique is safe and effective in managing chronic total arterial occlusive disease of the lower limbs.