Management of Critical Lower Limb Ischemia through Transpedal Approach

Introduction: Until recently, the inability to cross tibial lesions in an antegrade fashion was accepted as a failure of interventional therapy and an indication for an open surgical approach. In 1990, Iyer and colleagues described the use of a retrograde pedal/tibial approach to handle cases in which the conventional way of crossing the tibial lesion had failed. Aim of the Work: To assess transpedal approach in vessel recanalization on failure of re-entry to distal true lumen during antegrade approach or in presence of limited patent distal artery. Patients and Methods: The study was performed on 14 limbs in 14 patients with critical lower limb ischemia for whom percutaneous transluminal angioplasty was failed via antegrade approach. Results: By using transpedal approach, clinical success rate after the procedure which was detected by immediate regaining of the pulse or clinical improvement was 13 cases from 14 cases (92.85%). Conclusion: Transpedal approach is an ideal line of intervention in failure of re-entry of subintimal angioplasty or limited patent distal part of arterial tree.