{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:47:41Z","timestamp":1792010861998,"version":"4.4.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"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>Purpose<\/jats:title>\n                    <jats:p>Chronic limb-threatening ischaemia (CLTI) is associated with high rates of major amputation, mortality and comorbidity that can make conventional femoral access challenging or contraindicated; in particular in patients with recent groin surgery, infection, previous aorto-bifemoral stent reconstruction, hostile groins, or unfavourable body habitus. Tibio-pedal arterial minimally invasive retrograde revascularisation (TAMI) provides an alternative access strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective single-centre cohort study included 84 TAMI procedures in 81 limbs from 77 patients with CLTI (median age 72\u00a0years; 64% male; Rutherford IV 22%; Rutherford V\u2013VI 78%). TAMI was performed because of recent groin surgery\/infection in 35% of procedures and patient-related factors in 65%. The primary clinical endpoint was freedom from major adverse limb events (MALE), defined as major amputation or clinically driven target-vessel reintervention (CDTVR). Secondary endpoints included technical success, defined as restoration of continuous inline flow through at least one infrapopliteal artery to the foot with\u2009&lt;\u200950% residual stenosis on completion angiography, and access vessel safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Retrograde access was obtained predominantly via the dorsalis pedis (71%) and distal posterior tibial arteries (16%). Technical success was achieved in 66\/84 procedures (78%); in 10\/84 (12%), TAMI access and lesion crossing were successful but the predefined angiographic endpoint was not met, while eight procedures (10%) were abandoned. Asymptomatic access vessel spasm was documented in 35\/84 procedures (42%) that had resolved by 24\u00a0h. Among 68 patients (71 limbs) with longitudinal follow-up, median follow-up was 150\u00a0days (IQR 76\u2013322). CDTVR occurred in 22\/71 limbs (30%) and major amputation in 14\/71 (20%); 25\/68 patients (37%) died. Kaplan\u2013Meier estimated freedom from MALE was 57.9% (95% CI 43.9\u201369.6%) at 6\u00a0months and 51.2% (95% CI 36.0\u201364.5%) at 12\u00a0months. In multivariable Cox regression analysis, none of the evaluated covariates was significantly associated with MALE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this selected, anatomically complex CLTI cohort, TAMI was a feasible alternative access strategy when conventional femoral access was challenging or not feasible, with a low observed rate of clinically significant pedal access complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42155-026-00786-5","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:11:02Z","timestamp":1792008662000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Retrograde access revascularization in chronic limb threatening ischaemia"],"prefix":"10.1186","volume":"9","author":[{"given":"Yujia","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Patrone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthie","family":"Papadopoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Woodward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice","family":"Tsui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Portou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanka","family":"Benaragama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3088-2775","authenticated-orcid":false,"given":"Conrad","family":"von Stempel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"issue":"6","key":"786_CR1","doi-asserted-by":"publisher","first-page":"3S","DOI":"10.1016\/j.jvs.2019.02.016","volume":"69","author":"MS Conte","year":"2019","unstructured":"Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69(6):3S-125S.e40. https:\/\/doi.org\/10.1016\/j.jvs.2019.02.016.","journal-title":"J Vasc Surg"},{"issue":"4","key":"786_CR2","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1007\/s00270-011-0230-y","volume":"35","author":"P Minko","year":"2012","unstructured":"Minko P, Katoh M, Gr\u00e4ber S, Buecker A. Obesity: an independent risk factor for insufficient hemostasis using the AngioSeal vascular closure device after antegrade puncture. Cardiovasc Intervent Radiol. 2012;35(4):775\u20138. https:\/\/doi.org\/10.1007\/s00270-011-0230-y.","journal-title":"Cardiovasc Intervent Radiol"},{"key":"786_CR3","unstructured":"Mustapha JSFMA, NZSMMSGP. Retrospective Analysis of Peripheral Vascular Intervention Procedural and Safety Outcomes With Utilization of the Terumo Glidesheath Slender for Tibiopedal Access. J Crit Limb Ischem 2023;3(1):E12-E17."},{"issue":"3","key":"786_CR4","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1002\/ccd.28639","volume":"95","author":"JA Mustapha","year":"2020","unstructured":"Mustapha JA, Saab F, McGoff TN, et al. Tibiopedal arterial minimally invasive retrograde revascularization (TAMI) in patients with peripheral arterial disease and critical limb ischemia. On behalf of the Peripheral Registry of Endovascular Clinical Outcomes (PRIME). Catheter Cardiovasc Interv. 2020;95(3):447\u201354. https:\/\/doi.org\/10.1002\/ccd.28639.","journal-title":"Catheter Cardiovasc Interv"},{"issue":"6","key":"786_CR5","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1002\/ccd.30654","volume":"101","author":"R Minici","year":"2023","unstructured":"Minici R, Serra R, De Rosi N, et al. Endovascular treatment of femoro\u2010popliteal occlusions with retrograde tibial access after failure of the antegrade approach. Catheter Cardiovasc Interv. 2023;101(6):1108\u201319. https:\/\/doi.org\/10.1002\/ccd.30654.","journal-title":"Catheter Cardiovasc Interv"},{"issue":"11","key":"786_CR6","doi-asserted-by":"publisher","first-page":"463","DOI":"10.3390\/jcdd10110463","volume":"10","author":"HK Siu","year":"2023","unstructured":"Siu HK, Schultz E, LeBrun S, Liou M, Kwan TW. Safety of retrograde tibial-pedal access and intervention in patients with single remaining non-occluded infra-popliteal runoff artery. J Cardiovasc Dev Dis. 2023;10(11):463. https:\/\/doi.org\/10.3390\/jcdd10110463.","journal-title":"J Cardiovasc Dev Dis"},{"issue":"3","key":"786_CR7","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1177\/17085381241256022","volume":"33","author":"M Nezzo","year":"2025","unstructured":"Nezzo M, Meloni M, Carini A, et al. Efficacy of retrograde revascularization in diabetic patients with chronic limb-threatening ischemia after a failed antegrade approach. Vasc. 2025;33(3):717\u201324. https:\/\/doi.org\/10.1177\/17085381241256022.","journal-title":"Vasc"},{"issue":"6","key":"786_CR8","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1177\/17085381231192691","volume":"32","author":"D Raskin","year":"2024","unstructured":"Raskin D, Barash Y, Silverberg D, Halak M, Hater H, Khaitovich B. Retrograde tibial access for revascularization of chronic total occlusions in patients with chronic limb-threatening ischemia. Vasc. 2024;32(6):1220\u20135. https:\/\/doi.org\/10.1177\/17085381231192691.","journal-title":"Vasc"}],"container-title":["CVIR Endovascular"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00786-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42155-026-00786-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00786-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:11:02Z","timestamp":1792008662000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42155-026-00786-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["786"],"URL":"https:\/\/doi.org\/10.1186\/s42155-026-00786-5","relation":{},"ISSN":["2520-8934"],"issn-type":[{"value":"2520-8934","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]},"assertion":[{"value":"14 July 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Formal Research Ethics Committee approval and the requirement for informed patient consent in the study were waived in accordance with institutional policies governing retrospective analyses of anonymised clinical data.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written consent for publication of images was obtained.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Conrad von Stempel has received advisory board fees and speaker honoraria from Abbott, Shockwave Medical (Johnson & Johnson), BD Medical, and Medtronic. He has also received research funding from the British Heart Foundation, which did not support the current study.Lorenzo Patrone has received advisory board fees and speaker honoraria from Abbott, Asahi, BD Medical, Cook Medical, Terumo, and Shockwave Medical (Johnson & Johnson).Mark Portou has received advisory board fees and speaker honoraria from BD Medical and Shockwave Medical (Johnson & Johnson).All other authors declare that they have no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"132"}}