ArticleCVIR endovascular2026
Retrograde access revascularization in chronic limb threatening ischaemia.
Article in CVIR endovascular, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeChronic limb-threatening ischaemia (CLTI) is associated with high rates of major amputation, mortality and comorbidity that can make conventional femoral access challenging or contraindicated; in particular in patients with recent groin surgery, infection, previous aorto-bifemoral stent reconstruction, hostile groins, or unfavourable body habitus. Tibio-pedal arterial minimally invasive retrograde revascularisation (TAMI) provides an alternative access strategy. MATERIALS AND
methodsThis retrospective single-centre cohort study included 84 TAMI procedures in 81 limbs from 77 patients with CLTI (median age 72 years; 64% male; Rutherford IV 22%; Rutherford V-VI 78%). TAMI was performed because of recent groin surgery/infection in 35% of procedures and patient-related factors in 65%. The primary clinical endpoint was freedom from major adverse limb events (MALE), defined as major amputation or clinically driven target-vessel reintervention (CDTVR). Secondary endpoints included technical success, defined as restoration of continuous inline flow through at least one infrapopliteal artery to the foot with < 50% residual stenosis on completion angiography, and access vessel safety.
resultsRetrograde access was obtained predominantly via the dorsalis pedis (71%) and distal posterior tibial arteries (16%). Technical success was achieved in 66/84 procedures (78%); in 10/84 (12%), TAMI access and lesion crossing were successful but the predefined angiographic endpoint was not met, while eight procedures (10%) were abandoned. Asymptomatic access vessel spasm was documented in 35/84 procedures (42%) that had resolved by 24 h. Among 68 patients (71 limbs) with longitudinal follow-up, median follow-up was 150 days (IQR 76-322). CDTVR occurred in 22/71 limbs (30%) and major amputation in 14/71 (20%); 25/68 patients (37%) died. Kaplan-Meier estimated freedom from MALE was 57.9% (95% CI 43.9-69.6%) at 6 months and 51.2% (95% CI 36.0-64.5%) at 12 months. In multivariable Cox regression analysis, none of the evaluated covariates was significantly associated with MALE.
conclusionIn this selected, anatomically complex CLTI cohort, TAMI was a feasible alternative access strategy when conventional femoral access was challenging or not feasible, with a low observed rate of clinically significant pedal access complications.
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