Antegrade and retrograde access in the endovascular treatment of femoropopliteal chronic total occlusions

Abstract

Aim: In this study, the aim was to investigate whether antegrade or retrograde approaches are superior in the endovascular treatment of femoropopliteal chronic total occlusions (CTO). Material and Methods: A total of 437 patients who were diagnosed with CTO in the femoropopliteal region and who subsequently underwent endovascular procedures between February 2019 and April 2022 were evaluated retrospectively. The patients were grouped as antegrade access and retrograde access. All patients were classified according to the Rutherford and TASC (Transatlantic Intersociety Consensus II) classification. The patients were followed for 2 years. Above-ankle amputation and >50% stenosis in the target vessel were considered a failure. ABI, improvement in clinical symptoms, and limb salvage were evaluated in controls. Results: Antegrade approach was performed in 218 of the endovascular procedures. Antegrade recanalization was successful in 201 patients (92.2%), and failed antegrade attempt was seen in 17 because the lesion could not be crossed. Retrograde approach was used in 197 of endovascular interventions. Successful retrograde recanalization was unsuccessful in 185 patients (93.9%), and retrograde intervention was unsuccessful in 12 patients because the lesion could not be crossed. When the two-year restenosis numbers were examined, it was 61 (30.3%) in the antegrade group, while it was 49 (25.5%) in the retrograde group, and there was a significant difference between the groups. When the one-year stent occlusions between the groups were examined, it was 14 (6.9%) in the antegrade group and 8 (4.1%) in the retrograde group, and there was a statistically significant difference between the groups. Conclusion: The retrograde approach is as effective and safe as the antegrade approach in the treatment of femoropopliteal CTO. It should be noted that it can be used as an alternative method without the need for any support device, especially in cases where the antegrade approach is unsuccessful.