Trans Pedal Access for Revascularization of Arterial Occlusive Disease of The Lower Limb

Hamoda, Mohamed I.; Abbas, Reda O.; Shaban, Mostafa M.

doi:10.21608/aimj.2025.446594

Trans Pedal Access for Revascularization of Arterial Occlusive Disease of The Lower Limb

Document Type : Original Article

Authors

Vascular Surgery, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt

10.21608/aimj.2025.446594

Abstract

Background: Peripheral artery disease affects millions worldwide. The trans-pedal approach offers a viable alternative for revascularization in complex cases, with specific advantages and technical challenges.
Aim: To assess retrograde trans-pedal/tibial access as an alternative for endovascular treatment in critical limb ischemia. This approach is increasingly used for complex infrainguinal occlusions.
Patients and methods: this prospective research involved fifty cases of Faculty of Medicine -Al-Azhar University hospital with atherosclerotic occlusive arterial disease. The diagnosis of underlying arterial ischemia in every case will be determined through case history, physical examinations, and the utilization of color Doppler ultrasonography or computed tomography angiography.
Results: At 1-month follow-up, primary patency and limb salvage rates were 100% by duplex scan. At 6 months, primary patency was 90% (conservative treatment), with 100% limb salvage and no re-angioplasty needed. Complications included a 34% failure rate (68% [11/17] due to calcified access failure [7 PTA, 3 ATA, 1 PA]; 32% [6/17] due to lesion crossing failure [5 cases] or tibioperoneal trunk wiring [1 case]), 2 conservatively treated hematomas, 1 conservatively treated infection, and 1 peroneal artery perforation (balloon-controlled). Amputation occurred in 16% (8 above-knee cases): 3 due to access failure (2 prior antegrade, 1 retrograde transpedal) and 5 due to lesion crossing failure (4 prior antegrade, 1 retrograde transpedal).
Conclusion: Retrograde trans-pedal access is a promising and safe option for limb salvage in CLI cases, especially when conventional methods fail. It offers high success with low complication rates and growing clinical relevance.

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