Distal Retrograde Access for Infrainguinal Arterial Chronic Total Occlusions: A Prospective, Single Center, Observational Study in the Office-Based Laboratory Setting.

Objective: To assess the safety and efficacy of retrograde arterial recanalization of infrainguinal CTOs in the OBL setting.

Methods: Consecutive patients who underwent interventions for lower extremity CTOs in the OBL setting by a single vascular surgeon were evaluated (January 2013-November 2017). If antegrade crossing was not possible, then a retrograde distal approach was used. Patient characteristics, CTO location, procedural time, contrast, anticoagulation and radiation doses and costs were recorded. Post-procedural complications were documented on post-procedure day 1 and 10-14 days post procedure. Three groups were compared: -antegrade approach for femoropopliteal CTOs; -antegrade approach for tibial CTOs, and; -retrograde approach for femoropopliteal and tibial CTOs.

Results: Two hundred and thirty-seven patients were studied. In 39 (16.5%), the lesions could not be crossed. A successful antegrade approach was used in 185 of them, of which 69% (, n = 128) patients had femoropopliteal CTOs and 31% (, n = 57) had tibial CTOs. Fourteen patients (5.9%, ) were treated by retrograde distal approach. patients received higher contrast doses than and ( 0.01). However, patients in and received similar contrast doses. patients had the highest operative time and treatment costs followed by and then ( 0.01). Three femoral pseudoaneurysms were noted in , and 2 in . No complications were seen in .

Conclusions: Although the operative times, costs, radiation and contrast dose are higher with retrograde arterial access, it represents a safe and effective method for the crossing of CTO infrainguinal lesions in an ambulatory venue.