O-036 - SINGLE RETROGRADE PUNCTURE FOR ENDOVASCULAR TREATMENT OF PERIPHERAL ARTERIAL DISEASE

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Dubosq M. (Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris ~ Boulogne-Billancourt ~ France) , Renard R. (Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France ~ Paris ~ France) , Jayet J. (Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt ~ Paris ~ France) , Labed P. (Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France ~ Paris ~ France) , Javerliat I. (Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt ~ Paris ~ France) , Coggia M. (Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt ~ Paris ~ France) , Castier Y. (Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France ~ Paris ~ France) , Coscas R. (Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt ~ Paris ~ France)
Introduction:
The femoral artery puncture is deemed at risk of complications in several situations (obesity, history of groin surgery, anticoagulation therapy). Angioplasty with or without stenting by single retrograde puncture of a distal artery has been described (Tibiopedal Arterial Minimally Invasive Retrograde Revascularization - TAMI) but the data remain limited. We present here a bi-centric feasibility and safety study of the TAMI technique.
Methods:
For the TAMI technique, an ultrasound-guided retrograde puncture of the pedal artery or the posterior tibial artery was performed and generally followed by the use of 4Fr endovascular material in an ambulatory setting. Larger devices were used when appropriate, at the discretion of the treating surgeon. Closure of the puncture site was obtained by a 10 minutes manual compression. Patients were allowed to walk three hours after the procedure. The one-month postoperative visit systematically included a duplex-scan evaluation of the puncture site. Demographics, intraoperative and follow-up data of all consecutive patients treated with the TAMI technique were collected retrospectively. Results are expressed as numbers with percentages or means with standard deviations (SD) when appropriate.
Results:
Between August 2019 and March 2022, 37 limbs were treated in 30 patients using the TAMI technique (7 simultaneous bilateral procedures). Among them, 59 % (N=22) were at high risk for a femoral puncture and 49 % (N= 18) presented with a critical limb threatening ischemia. The lesions were mostly located on the femoropopliteal axis (95 %; N=35) with a mean length of 97.5±48.9 mm and 23 (62%) chronic total occlusions (CTO). The Trans-Atlantic Inter-Society Consensus II classification was generally B (62 %) but also C (32 %) or D (6 %). Most procedures were achieved under local anaesthesia with sedation 86 % (N=32). The punctured artery was the posterior tibial artery in 70 % (N=26) of cases and the pedal artery in 30 % (N=11) of cases. A 4 Fr sheath was used in 31 cases but 5 Fr and 6 Fr sheaths were necessary in 3 limbs each. In one CTO procedure, a re-entry device was used through the single retrograde access. A bail-out sheathless femoral puncture was necessary to insert an anterograde wire in 2 CTO procedures. Thirty procedures (81 %) required stenting (1.56±0.91 stents per procedure). In 4 cases (11%) drug-coated balloons were used. The operative duration was 68.3±22.1 minutes and the fluoroscopy time was 11.2±7.5 minute. The amount of iodinated contrast media injected was 45.5±32.1 mL. The technical success rate was 100%. All patients could walk the same day. In total, 50 % (N=15) of the patients were performed on an outpatient basis while others left hospital the day after the procedure, mainly for social reasons. No intraoperative or postoperative complications were reported. At 30 days, the patency of the treated artery and the punctured artery were respectively 97 % (one stent thrombosis managed medically) and 100 %.
Conclusion:
The TAMI technique is feasible and safe both for the punctured and the treated arteries. It avoids the need for an arterial closure device or a compression bandage at the groin and thus contributes to improve patients' comfort. It represents an alternative in case of femoral puncture at risks and could increase the feasibility of same-day discharge procedures. Prospective studies comparing femoral and distal accesses on larger populations are necessary to confirm our results.