Clinical Outcomes and Cost Implications of Recanalization for Complex Femoropopliteal Occlusive Disease Using a Retrograde Tibial Approach After Failed Infragenicular Bypass

Bibombe Mwipatayi P1,2,3*, Joseph Faraj1, Ali Daneshmand1, Olufemi Oshin1, Daniela L Mwipatayi3 and Jackie Wong3

1Department of Vascular Surgery, Royal Perth Hospital, Australia
2Department of Medicine, University of Western Australia, Australia
3Department of Vascular Surgery, Perth Institute of Vascular Research, Australia

^*Correspondance to: Bibombe Mwipatayi P 

 PDF  Full Text DOI: 10.25107/2474-1647.2840

Abstract

Purpose: We report the mid-term outcomes of the Controlled Antegrade Retrograde Subintimal Tracking (CART) or reverse CART (r-CART) technique in patients who underwent recanalization for femoropopliteal occlusive disease after an occluded infragenicular bypass and the costeffectiveness of the retrograde approach. Methods: A case-series study was performed in all patients who underwent retrograde recanalization for complex femoropopliteal occlusive disease at our centre, with data prospectively collected from November 2015 to April 2018. The assigned costs for the economic evaluation were the initial hospitalization and all perioperative admission-related complications. Results: A total of 185 patients underwent femoral and/or popliteal artery intervention. Fifty-five patients were identified as suitable for the retrograde approach after failed antegrade recanalization and were included in this registry. A total of 40 patients underwent a retrograde approach but never had infragenicular bypass surgery (group A patients), whereas 15 patients underwent previous placement of an infragenicular bypass graft that occluded despite patent tibial vessel run-off (group B patients); the mean lesion lengths were 24.4 ± 8.1 cm vs. 34.9 ± 3.7 cm, respectively, and this difference was significant (P=0.03). The overall median procedure time in both groups was 107.7 ± 49.8 minutes (range, 175 min to 503 min), with an overall median fluoroscopy time of 27.7 ± 12.1 minutes (range, 38 min to 105 min) and a contrast volume of 133.2 ± 63.7 mL (range, 31 mL to 121 mL). However, the duration of fluoroscopy was significantly different between the two groups of patients (30.4 ± 12.0 minutes vs. 20.8 ± 9.6 minutes; P= 0.01). The retrograde approach cost ($25106 ± 8700) was significantly higher than the cost for patients who underwent the antegrade approach ($17337 ± 7827, P=0.002). The average total cost per patient after procedural admission was 1.5-fold higher for the retrograde approach than for the antegrade approach (P<0.001). Conclusion: We suggest that retrograde revascularization should be considered a part of the complete armamentarium in the management of femoropopliteal occlusive disease, primarily in long and heavily calcified lesions after failure of the antegrade approach, even in patients with failed previous infragenicular bypass surgery. The increased initial treatment costs can be offset by the benefits of this procedure.

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Cite the article

Bibombe Mwipatayi P, Faraj J, Daneshmand A, Oshin O, Mwipatayi DL, Wong J. Clinical Outcomes and Cost Implications of Recanalization for Complex Femoropopliteal Occlusive Disease Using a Retrograde Tibial Approach After Failed Infragenicular Bypass. Clin Surg. 2020; 5: 2840.