Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of General Surgery

Purpose: the aim is to evaluate the role retrograde access technique as a bailout technique after failure of antegrade angioplasty in cases of critical limb ischemia.Patients and methods: our study included 25 patients with critical limb ischemia.Patients with non-salvageable limbs, acute ischemia, trauma, aneurysms, connective tissue disorders and arteritis were excluded. All patients had CLI (Rutherford 4 to 6) access used was contralateral femoral access, ipsilateral femoral access, and then retrograde access.Results: mean Patients{u2019} age was 63 years, male to female ratio 3:2. Patients{u2019} presentation was rest pain, minor, major tissue loss and claudications in 3,21,1 patients respectively.The access used was initially ipsilateral or contralateral femoral access then retrograde access through distal femoral artery, ATA, PTA & Peroneal arteries in 2,8,7& 8 patients respectively. Angioplasty was done to all cases except one case failed to cross the lesion. Stents were used in 13 cases, DEB in 7 cases and thrombolytic therapy in 2 cases. Re-entry devices were not used Conclusion: Retrograde access is a safe with high success rate technique in cases of critical limb ischemia if the lesion cannot be crossed through antegrade technique

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