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We wanted to study success rate, safety and efficacy of tibio-pedal access (TPA) as primary access and as the only access for revascularization of peripheral artery disease (PAD).
We performed retrospective review of a single center case series of using TPA as a preferred access for PAD intervention. Patients suffering from symptomatic PAD (Rutherford Class II-V) were treated with the intention of using only ipsilateral TPA if there was antegrade flow in one of the three runoff vessels on ultrasound (US). Radial access (RA) or contralateral femoral access (FA) were used only if needed for procedural success. TPA was secured with US guidance using a 6 Fr slender hydrophilic sheath (Terumo Corporation) in each case. Choices of intervention devices were customized for the disease treated (Figure). Radial compression devices were used to achieve hemostasis. At 30 days follow-up target limb vessel US was performed.
“Pedal first” approach was attempted for treating 41 legs in 36 patients. 39 legs (95%) were revascularized successfully with TPA success rate of 95% and “pedal only” success rate of 77%(table). Two procedures were unsuccessful. All but 5 patients with FA were able to sit-up immediately and ambulate at average 3 hrs. No patient had access vessel thrombosis or required emergency surgery. At 30 days on US evaluation all treated vessels and accessed artery were patent except one SFA stent thrombosis.
“Pedal first” approach of using tibio-pedal access as a primary access and as the only access is safe and highly successful in carefully selected patients.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention