Transpedal Access for the Management of Complex Peripheral Artery Disease

OBJECTIVES: To evaluate the safety and efficacy of transpedal access for the management of complex peripheral artery disease (PAD). INTRODUCTION: Critical limb ischemia is associated with high risk of limb loss, as well as cardiovascular and all-cause mortality. Transpedal access is a novel, increasingly utilized technique for the management of complex PAD. METHODS: We performed a literature search using PubMed from January 2003 to December 2016. Published studies on transpedal access were studied. We evaluated patient sample demographics, procedure indications, access and target vessel, procedural characteristics, outcomes, and complications. RESULTS: Ten studies and 881 patients were included in our study. The indication for transpedal access was critical limb ischemia in 68.4% and severe claudication in 29.5%. A chronic total occlusion was present in 93.7% (average occlusion length, 206 mm). Access was achieved by ultrasound in 57.1% and by fluoroscopy in 35.7%. The anterior tibial or dorsalis pedis were accessed in 54.7% and the posterior tibial in 28.0%. The angiographic procedural success rate was 92.6%. The most commonly reported complication was dissection (7.49%), followed by perforation (1.36%) and embolization (1.25%). CONCLUSION: Based on the results of this systematic review, transpedal access appears to be a safe and effective technique for complex PAD.