Tibio‐pedal arterial minimally invasive retrograde revascularization in patients with advanced peripheral vascular disease: The TAMI technique, original case series

• Published in: Catheterization and cardiovascular interventions 2014-05, Vol.83 (6), p.987-994
• Main Authors: Mustapha, J.A., Saab, Fadi, McGoff, Theresa, Heaney, Carmen, Diaz‐Sandoval, Larry, Sevensma, Matthew, Karenko, Barbara
• Format: Article
• Language: English
• Subjects: Aged; Constriction, Pathologic; Critical Illness; critical limb ischemia; endovascular; Endovascular Procedures - adverse effects; Endovascular Procedures - methods; Feasibility Studies; Female; Humans; Ischemia - diagnosis; Ischemia - physiopathology; Ischemia - therapy; Male; Michigan; Patient Positioning; Patient Selection; Peripheral Vascular Diseases - diagnosis; Peripheral Vascular Diseases - physiopathology; Peripheral Vascular Diseases - therapy; Radiography; Retrospective Studies; Risk Factors; Severity of Illness Index; tibial access; Tibial Arteries - diagnostic imaging; Tibial Arteries - physiopathology; Time Factors; Treatment Outcome; Ultrasonography, Interventional; ultrasound; Vascular Patency
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.25227

Background A tibial‐pedal access method is needed for patients with advanced peripheral artery disease (PAD) unable to tolerate common femoral artery (CFA) access and intervention due to body habitus or comorbidities. This is the first case series reporting an alternative technique to revascularize such patients. Using ultrasound (US) and the tibio‐pedal arterial minimally invasive retrograde revascularization (TAMI) technique, operators accessed, and revascularized the lower extremity completely via tibial‐pedal arterial access. Methods This retrospective, single‐center, case series recorded on 23 patients who underwent TAMI revascularization during a seven‐month period in 2012, demonstrating the feasibility and safety of the TAMI technique. Eighty‐three percent had Rutherford Classification IV–VI. Ultrasound guidance aided all tibial access. Demographics, vascular symptoms, disease characteristics, success, procedure length, time to discharge, immediate and 30‐day complications were collected. Comparison was sought with 201 unmatched patients treated via traditional CFA access over a similar period. Results Arterial access was successful in all patients. Thirty‐six lesions were treated. Lesion success (ability to cross lesion and achieve post treatment stenosis