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; p = 0.003). Additionally, the average Saint Elian Wound Score System (SEWSS) decreased significantly (Preprocedural 14.9 ± 4.0 vs Postprocedural 11.3 ± 4.7, p < 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.