Discussion: Pedal Artery Access for Critical Limb Ischemia

A blog post from Vascular Disease Management published last month generated some discussion. “Pedal Artery Access for Critical Limb Ischemia” by Robert S. Dieter, MD, RVT, and Aravinda Nanjundappa, MD, RVT, highlights the challenges of revascularizing lower extremity ischemia. The authors encourage all vascular specialists to learn more about pedal access for treating this condition.

One reader shared some concerns about the technique:

1. If that is your go-to vessel for a fem distal bypass, why would you risk accessing it and possibly destroying the vessel?
2. Technical success rate may be high, but what is your patency rate? I am not talking about a TASC A or B lesion in the SFA. I am talking about a TASC C or D tibial.
3. Lastly, there is the time commitment in the lab to first gain access in the pedal vessel, pass through the lesion (if not done expeditiously – and by no means does it take less than 5 minutes thus far), access the femoral, snare, then have to deliver small 1.5 mm balloons, followed by 2.0 then 2.5 mm balloons, possibly atherectomizing, and in the end having technical success but only to shut down in less than 2 weeks. The cost to the hospital cause we know they will never make the money back versus doing bypass. If the patient is truly not a surgical candidate and if they have gangrene what is wrong with going straight to amputation and getting the patient back to some quality of life faster.

Dr. Nanjundappa responded, noting that yes, there are times that the patient will undergo a femoral artery distal bypass, but morbidity must be carefully considered. And, says Nanjundappa, “Amputation does not improve quality of life in all patients, on the contrary most studies have demonstrated increased cardiovascular morbidity and mortality.”

Read more of this discussion on pedal access and share your thoughts in the comments at the bottom of the page.


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