CardioVascular and Interventional Radiology

, Volume 39, Issue 12, pp 1692–1701 | Cite as

Routine Use of Surgical Retrograde Transtibial Endovascular Approach for Failed Attempts at Antegrade Recanalization of Chronic Peripheral Artery Total Occlusions

  • GangZhu Liang
  • FuXian ZhangEmail author
  • XiaoYun Luo
  • ChangMing Zhang
  • YaPing Feng
  • LuYuan Niu
  • Huan Zhang
  • Lu Hu
  • Hui Zhao
  • Long Cheng
  • MingYi Zhang
Clinical Investigation



Our aim was to describe the technical aspects and clinical outcomes of an open surgical approach to retrograde transtibial endovascular therapy for recanalization of chronic total occlusions (CTOs) of peripheral arteries because of inability to acquire antegrade intravascular access across the occlusion.

Materials and Methods

Between January 2011 and May 2014, conventional antegrade revascularization failed in 15 limbs of 15 patients (11 males, 4 females) with complex CTOs. The mean age of the patients was 74 years (range 48–83 years). Five patients had severe claudication (Rutherford Category 3), and 10 patients had critical limb-threatening ischemia (Rutherford Categories 4–5). For each of these cases of antegrade failure, an open surgical exposure of the tibial or dorsalis pedis artery was used to allow a safe retrograde transtibial endovascular approach to recanalize the CTO.


Surgical retrograde access from the tibial artery was achieved successfully in 14 of the 15 patients. In the 14 successful retrograde endovascular approaches, surgical retrograde transtibial access was achieved from the dorsalis pedis artery in 8 patients and from the posterior tibial artery in 6. The average time to obtain retrograde access was 5 min (range 2–11 min). No stenosis or occlusion occurred in the tibial or dorsalis pedis arteries used for the retrograde access sites during follow-up.


Routine surgical exposure can be a safe and an effective method for retrograde transtibial access to the more proximal occluded arterial segments in selected patients with CTO.


Arterial intervention Peripheral vascular disease Endovascular treatment Angioplasty Revascularization 


Compliance with Ethical Standards

Conflict of interest

We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work. There is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled, “Routine Use of Surgical Retrograde Transtibial Endovascular Approach for Failed Attempts at Antegrade Recanalization of Chronic Peripheral Artery Total Occlusions”.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2016

Authors and Affiliations

  • GangZhu Liang
    • 1
  • FuXian Zhang
    • 1
    Email author
  • XiaoYun Luo
    • 1
  • ChangMing Zhang
    • 1
  • YaPing Feng
    • 1
  • LuYuan Niu
    • 1
  • Huan Zhang
    • 1
  • Lu Hu
    • 1
  • Hui Zhao
    • 1
  • Long Cheng
    • 1
  • MingYi Zhang
    • 1
  1. 1.Department of Vascular Surgery, Beijing Shijitan HospitalCapital Medical UniversityPekingChina

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