{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T03:09:03Z","timestamp":1784171343748,"version":"3.55.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["CVIR Endovasc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Trans-ankle intervention (TAI) through retrograde distal access via below-the-knee and below-the-ankle arteries has been increasingly reported as an alternative approach for the treatment of femoropopliteal (FP) lesions. Although previous studies have described the procedural success of this strategy, its clinical feasibility and post-procedural outcomes remain insufficiently characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective single-center study, the data from 33 patients with 36 FP lesions who underwent endovascular therapy (EVT) between January 2024 and January 2025 were analyzed. The primary endpoint was procedural success. The secondary endpoints were clinical worsening of lower-limb ischemia within 30\u00a0days, 1-year freedom from clinically driven target lesion revascularization (CD-TLR), and procedural complications. The risk of post-procedure access vessel occlusion was also investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>TAI was performed via access sites ranging from the anterior tibial artery (ATA) to the dorsalis pedis artery in all patients. Procedural success was achieved in all cases, and the rate of 1-year freedom from CD-TLR was 91.8%. All patients had FP lesions, including three cases up to the iliac artery. Forty-two percent was chronic total occlusion, and EVT of the ATA was required in 42% of the cases to establish the access route. Ten cases (27.8%) were approached via the occluded pre-ATA, and 15 (41.7%) required intervention to approach the vessel. The average number of pre-procedural and post-procedural below-the-knee artery runoff vessels was 2.4 and 2.75, respectively. No patients showed clinical worsening within 30\u00a0days. The risk factors for ATA occlusion were hemodialysis, ATA intervention, and approach via the occluded ATA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TAI may represent a feasible result, especially for selected FP lesions. Although no clinical worsening was observed, an increased risk of postoperative ATA occlusion existed in patients on hemodialysis and those with access site atherosclerosis requiring ATA intervention. However, in these high-risk populations, this limitation may potentially be overcome by an approach through the occluded ATA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42155-026-00735-2","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T02:53:34Z","timestamp":1784170414000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical feasibility of primary retrograde endovascular therapy via trans-ankle intervention: a retrospective single-center study"],"prefix":"10.1186","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4785-7452","authenticated-orcid":false,"given":"Hiromi","family":"Miwa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Hayakawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiki","family":"Tsurumaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuyuki","family":"Tsuchida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanao","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Ichihara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunichi","family":"Kushida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"issue":"24","key":"735_CR1","doi-asserted-by":"publisher","first-page":"e1313","DOI":"10.1161\/CIR.0000000000001251","volume":"149","author":"HL Gornik","year":"2024","unstructured":"Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, et al. 2024 ACC\/AHA\/AACVPR\/APMA\/ABC\/SCAI\/SVM\/SVN\/SVS\/SIR\/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. 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J Cardiovasc Dev Dis. 2023. https:\/\/doi.org\/10.3390\/jcdd10110463.","journal-title":"J Cardiovasc Dev Dis"}],"container-title":["CVIR Endovascular"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00735-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42155-026-00735-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00735-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T02:53:36Z","timestamp":1784170416000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42155-026-00735-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["735"],"URL":"https:\/\/doi.org\/10.1186\/s42155-026-00735-2","relation":{},"ISSN":["2520-8934"],"issn-type":[{"value":"2520-8934","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]},"assertion":[{"value":"9 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All procedures were performed in accordance with the ethical standards of the institutional and\/or national research committees and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study protocol was approved by the ethics committee of Asahi General Hospital.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"N. H. is a consultant for Reflow Medical and received honoraria from Terumo, Kaneka Medix, Medicos Hirata, Boston Scientific, Medtronic, Reflow Medical, SIEMENS, Cordis, Abbot Vascular, and Becton, Dickinson and Company. The other authors declare that they have no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"88"}}