Combined retrograde-antegrade arterial wiring: Peroneal artery can be a bridge to cross infrapopliteal Trans Atlantic Inter Society Consensus D lesions.

BACKGROUND: Percutaneous transluminal angioplasty of complex infrapopliteal lesions might be a true and complex challenge. Success rates remain suboptimal when employing standard approaches. Thus, recanalization techniques for infrapopliteal disease remain a seat of continuous evolution.

AIM OF THE STUDY: We report our results of Trans Atlantic Inter Society Consensus D infrapopliteal disease recanalization using combined antegrade-retrograde approach through peroneal artery branches.

PATIENTS AND METHODS: A total of 27 patients with infrapopliteal Trans Atlantic Inter Society Consensus D lesions underwent recanalization of at least one of the tibial arteries by combined retrograde-antegrade route using the peroneal artery normal anastomosis channels.

RESULTS: Technical success was achieved in 22 patients who were followed for 6-24 months. Healing of ischemic ulcers or spontaneous separation of ischemic gangrenous patches in 13 patients. Minor amputation in nine patients. No major amputation in the follow-up period.

CONCLUSION: Although demanding, the technique can be reserved for selected cases with failed antegrade recanalization. This technique is valuable when a proximal occlusion is not crossable, when a dissection flap or a perforation in the proximal portion of a target vessel hinders guide-wire advancement. This technique may represent a feasible endovascular option to avoid second distal puncture exhausting the landing zone of a future distal bypass.