Impact of transpedal retrograde wire just marker technique on revascularization of below the knee artery occlusions with ambiguous proximal caps in patients with Buerger's disease.

Background: Chronic total occlusions with ambiguous proximal caps present a significant challenge in endovascular interventions of patients with Buerger's disease.

Objective: We aimed to evaluate the effectiveness of transpedal retrograde wire just marker technique in patients with Buerger's disease presenting proximal cap ambiguity and flush occlusions.

Methods: Seventeen patients with the diagnosis of Buerger's disease who had below the knee artery chronic total occlusions with ambiguous proximal caps were enrolled. Procedural success, post-intervention Rutherford stage, wound scores, pedal loop scores, and amputation rates were recorded.

Results: Final study group consisted of 13 patients after exclusion of 4 patients due to pedal loop formation failure and severe vasospasm preventing equipment advancement. Post-intervention angiographic success rate was 100%. The post-intervention Rutherford stage showed excellent improvement (mean preprocedural Rutherford stage = 5 vs mean post-intervention Rutherford stage = 2; = 0.003). Additionally, the average Saint Elian Wound Score System (SEWSS) decreased significantly (Preprocedural 14.9 ± 4.0 vs Postprocedural 11.3 ± 4.7, < 0.001) after the interventions. Two patients had a major amputation during the follow-up indicating that higher post-intervention pedal loop scores are associated with higher amputation rates.

Conclusions: Transpedal retrograde wire just marker technique is an effective and practical method for revascularization of below the knee artery occlusions with ambiguous proximal caps. Including pedal loop angioplasty as a routine part of this technique can significantly increase blood supply to the pedal arch., thereby enhancing the likelihood of wound healing.