Chun-Yang Huang
Current Position
Attending physician
Taipei Veterans General HospitalNational Yang Ming Chiao Tung University Hospital
Peripheral Artery Session

Topic: The short and long-term outcome of tibiopedal and distal femoral retrograde vascular access for Asian in complex chronic total occlusion lesion


The recent study revealed retrograde puncture is a safe option after a failed antegrade approach and complication at the puncture side were also rare. However, study population is Caucasian dominantly but Asian population is rare. Vessel size discrimination has been mentioned in previous study that display Asians is smaller than western. This retrospective study aims to clarify if retrograde puncture is an efficacious and safe procedure for Asian patients with small vessel and follow up the outcome for long-term.
Materials and methods
Retrospective non-randomized study between January 2018 to December 2020 in single center. One hundred and twenty-three consecutive patients with symptomatic PAD undergoing tibiopedal or distal femoral artery retrograde puncture for endovascular intervention were included in Taipei Veterans General Hospital. Preoperative, peri-procedure, postoperative complication and long-term outcome of retrograde vascular access were evaluated.
The mean age received interventions was 74.7±12.1 years with 123 limbs. The puncture side included 30.1% at distal SFA or POPA, 15.4% at ATA, 30.9% at PTA, 6.5% at PA, and 17.1% at DA. Mean vessel diameter of puncture side was 4.5mm at distal SFA or POPA, 2.6mm at ATA, 2.5mm at PTA, 2.3mm at PA, and 2.2 at DA. The puncture successful rate was 97.6% (120/123) and the total cannulation successful rate was 76.7% (92/120). In puncture side complication, three limbs suffered from hematoma formation (2.5%), one was distal embolism (0.8%), seven was focal dissection (5.8%), and two were compartment syndrome (1.7%) after intervention. Freedom from CD-TLR, freedom from amputation, and freedom from MALE were 87.9%, 98.9%, and 72.3% at 4 years.
For Asian, retrograde puncture method was still saft and effective if antegrade failed. The long-term outcome doesn’t infer to previous studies. However, small caliber vessel may cause significant focal dissection when device worked in the true lumen.