Access Vessel Patency After Endovascular Therapy via Tibiopedal Access in Patients With Lower Extremity Artery Disease.

Abstract

Purpose: This study aimed to evaluate the access vessel patency after endovascular therapy performed via tibiopedal access.

Materials and methods: This was a retrospective, single-center, observational study. Patients who underwent endovascular therapy via tibiopedal access with sheath insertion were enrolled. The primary outcome was loss of access vessel patency defined as access vessel occlusion or stenosis with a peak systolic velocity ratio > 2.4 on duplex ultrasound at 6 months. Multivariate logistic regression analysis was performed to identify the predictors of access vessel patency loss, with hemodialysis, severely calcified access vessel and sheath-to-artery ratio included as covariates.

Results: A total of 95 limbs in 91 patients were included in this study, and loss of access vessel patency was observed in 22 limbs (23.1%). Multivariate logistic regression analysis demonstrated that sheath-to-artery ratio was the only independent predictor (odds ratio: 1.493, 95% confidence interval: 1.130-1.976; p = 0.005). The receiver operating characteristic curve analysis revealed that the optimal cutoff value of sheath-to-artery ratio for predicting loss of access vessel patency was 1.08, with an area under the curve of 0.723. In this cohort, the 2-year freedom from major adverse limb events were 98.6% (95% CI: 90.8-99.8%), and no major amputation occurred.

Conclusion: The present study demonstrated a relatively high incidence of loss of access vessel patency after endovascular therapy via tibiopedal access, although this was not associated with an increase in major adverse limb events. A larger sheath-to-artery ratio was identified as an independent predictor of loss of access vessel patency.