How I do it: Pedal access and pedal loop revascularization for patients with chronic limb-threatening ischemia

Marcos T Kuroki; Umang M Parikh; Venita Chandra

doi:10.1016/j.jvscit.2023.101236

How I do it: Pedal access and pedal loop revascularization for patients with chronic limb-threatening ischemia

J Vasc Surg Cases Innov Tech. 2023 May 25;9(3):101236. doi: 10.1016/j.jvscit.2023.101236. eCollection 2023 Sep.

Authors

Marcos T Kuroki¹, Umang M Parikh¹, Venita Chandra¹

Affiliation

¹ Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.

Abstract

An increasing proportion of patients with chronic limb-threatening ischemia are older and have multiple comorbidities, including diabetes and renal failure. For those who are not candidates for a surgical bypass, this set of patients presents a challenge to vascular surgeons and interventionalists owing to the complex below-the-knee and increasingly below-the-ankle disease pattern that can fail traditional approaches for endovascular intervention. Two techniques, the retrograde pedal access and the pedal-plantar loop technique, can be useful in these settings and in skilled hands can be used safely, with a high technical success rate. In patients with chronic limb-threatening ischemia who are not candidates for a single-segment saphenous vein bypass, the retrograde pedal access technique can be used not only in the setting of failed antegrade treatment, but also primarily when faced with a difficult groin or as an adjunct during a planned antegrade-retrograde intervention. The pedal plantar loop technique allows for retrograde access to tibial vessels without retrograde vessel puncture and additionally offers the ability to treat the pedal-plantar arch, which may have added benefit in wound healing. We describe the tips and tricks for these two techniques used in our limb salvage practice.

Keywords: CLTI; Limb salvage; Pedal access; Pedal arch revascularization; Pedal loop revascularization; Pedal-plantar arch; Pedal-plantar loop; Retrograde access.