[MP-5] The efficacy and safety of retrograde approach using distal puncture for BTK-CTO lesion in CLI patients.
Background: Distal puncture was one of the strategy that perform EVT for BTK-CTO lesion in critical limb ischemia patients. However, distal puncture might have the risk of hemostasis, the wound of needle that might become wound formation, and the vascular injury that might cause stenosis or occlusion. Aim: We investigated that success ratio of EVT using distal puncture and the complication of distal puncture for BTK-CTO lesion in CLI patients. Method: This was single center observation study. From 2007 to 2017, we performed EVT for about 400 CLI patients. From them, 31 cases were performed by distal puncture and analyzed. Result: Mean age was 73±10 years old. Patients on HD accounted 23 cases (74%). Patients with Rutherford class 4 , 5, and 6 constituted 4 cases (13%), 15 cases(48%), and 6 cases(39%). 28 cases (90%) was successful EVT for BTK-CTO lesion. The complication was occurred in 1 cases (3%). The case had the difficulty of puncture site hemostasis that required prolonged balloon inflation.Wound healing ratio at 1 year was 58%. Amputation free survival at 1 year was 44%. Post EVT angiogram was performed in 19 cases. In these cases, there was no cases that occurred puncture site stenosis or occlusion. Conclusion: Distal puncture for BTK-CTO lesion provides high success ratio. The complication ratio was acceptable.