{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T22:21:46Z","timestamp":1767651706134},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,11,15]],"date-time":"2013-11-15T00:00:00Z","timestamp":1384473600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec><jats:title><jats:styled-content>Background<\/jats:styled-content><\/jats:title><jats:p>Successful angioplasty is one of the main factor of limb salvage during critical limb ischemia. In complex femoropopliteal to infrapopliteal occlusions, an anterograde recanalization attempt can fail in up to 20% of the cases. The purpose of this dual center pilot study was to evaluate the acute success and clinical impact of retrograde transpedal access for retrograde below\u2010the\u2010knee and femoropopliteal chronic total occlusions after failed anterograde attempt and to access the late complications at the puncture site.<\/jats:p><\/jats:sec><jats:sec><jats:title><jats:styled-content>Methods<\/jats:styled-content><\/jats:title><jats:p>The clinical and angiographic data of 51 consecutive patients with CLI treated by retrograde transpedal recanalization between 2010 and 2011 were evaluated in a pilot study. We have examined the 2\u2010month and 1 year major adverse events (MAEs) and clinical success. In all cases after failure of the anterograde recanalization of occluded below\u2010the\u2010knee segments due to unsuccessful penetration or failed re\u2010entry, the anterior tibial or posterior tibial artery was punctured under fluoroscopic guidance and retrograde recanalization was performed. Direct revascularization was tried firstly following the angiographic zones, but in failed cases indirect revascularization was carried out with increasing the collateral flow to the wound.<\/jats:p><\/jats:sec><jats:sec><jats:title><jats:styled-content>Results<\/jats:styled-content><\/jats:title><jats:p>Successful direct retrograde revascularization was achieved successfully in 40 patients (78.4%) and indirect revascularization was done in 10 patients (19.6%). Revascularization was failed in one patient (2%). MAE at 2 and 12 months follow\u2010up was 6 (11.7%) and 11 (24%). Limb salvage at 2 and 12 months was 93% and 82.3%, respectively. Balloon angioplasty was performed in all interventions and provisional stenting was done in 34 patients (66.7%). One major and three minor vascular complications occurred after the procedure. The mean basal and control creatinine level was 120.9\u2009\u00b1\u2009133.4 and 123.8\u2009\u00b1\u2009131.3 \u03bcmol\/L (<jats:italic>P<\/jats:italic>\u2009=\u20090.83) after the procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title><jats:styled-content>Conclusion<\/jats:styled-content><\/jats:title><jats:p>Failed antegrade attempts to recanalize CTO\u2010s of femoropopliteal and infrapopliteal vessels can be salvaged using a retrograde transpedal access, with a low acute and late complication rate. This technique could be valuable for patients with critical limb ischemia due to femoropopliteal and infrapopliteal occlusions. \u00a9 2013 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.25262","type":"journal-article","created":{"date-parts":[[2013,10,19]],"date-time":"2013-10-19T18:38:37Z","timestamp":1382207917000},"page":"997-1007","source":"Crossref","is-referenced-by-count":35,"title":["Transpedal access after failed anterograde recanalization of complex below\u2010the\u2010knee and femoropoliteal occlusions in critical limb ischemia"],"prefix":"10.1002","volume":"83","author":[{"given":"Zolt\u00e1n","family":"Ruzsa","sequence":"first","affiliation":[{"name":"Semmelweis University, Cardiac and Vascular Center Budapest Hungary"},{"name":"B\u00e1cs\u2010Kiskun County Hospital Teaching Hospital of the University of Szeged Invasive Cardiology Department Kecskem\u00e9t Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bal\u00e1zs","family":"Nemes","sequence":"additional","affiliation":[{"name":"Semmelweis University, Cardiac and Vascular Center Budapest Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zolt\u00e1n","family":"B\u00e1ns\u00e1ghi","sequence":"additional","affiliation":[{"name":"B\u00e1cs\u2010Kiskun County Hospital Teaching Hospital of the University of Szeged Invasive Cardiology Department Kecskem\u00e9t Hungary"},{"name":"Saint\u2010Imre Hospital Teaching Hospital of the University P\u00e9cs Radiology Department Budapest Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K\u00e1roly","family":"T\u00f3th","sequence":"additional","affiliation":[{"name":"B\u00e1cs\u2010Kiskun County Hospital Teaching Hospital of the University of Szeged Invasive Cardiology Department Kecskem\u00e9t Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ferenc","family":"Kuti","sequence":"additional","affiliation":[{"name":"B\u00e1cs\u2010Kiskun County Hospital Teaching Hospital of the University of Szeged Invasive Cardiology Department Kecskem\u00e9t Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Slavka","family":"Kudrnova","sequence":"additional","affiliation":[{"name":"Semmelweis University, Cardiac and Vascular Center Budapest Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bal\u00e1zs","family":"Berta","sequence":"additional","affiliation":[{"name":"Semmelweis University, Cardiac and Vascular Center Budapest Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K\u00e1lm\u00e1n","family":"H\u00fcttl","sequence":"additional","affiliation":[{"name":"Semmelweis University, Cardiac and Vascular Center Budapest 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