Background/Objectives In treating Peripheral Artery Disease (PAD), the contralateral femoral artery is commonly used for endovascular access. When antegrade access is not feasible, retrograde access via tibial or pedal vessels may be used. This study evaluates the impact of retrograde access on longitudinal outcomes using propensity score matching to emulate a randomized trial. Methods This retrospective analysis included patients who underwent endovascular revascularization at two institutions between 2014 and 2022. Retrograde access was defined as access via the anterior tibial, posterior tibial, peroneal, or dorsalis pedis artery. Major Adverse Limb Events (MALE) included arterial bypass, minor amputation, or major amputation. Propensity score matching was performed using known predictors of retrograde access: chronic kidney disease, gangrene, prior PAD surgery, chronic total occlusion, number of patent tibial vessels, age, and gender. Full matching minimized data loss. Univariate logistic regression estimated the effect size of retrograde access on MALE, reintervention, and death. Results After matching, 57 retrograde and 276 antegrade access patients were included. Covariate balance was achieved, with all absolute mean differences <0.1. Retrograde access was not significantly associated with reintervention (OR = 1.88, CI: 0.97-3.73, P = .065), death (OR = 1.74, CI: 0.84-3.46, P = .12), or MALE (OR = 1.32, CI: 0.67-2.51, P = .4). Conclusion Retrograde access does not significantly impact the odds of adverse outcomes and is a viable option when antegrade access is not feasible. However, elevated odds ratios and limited sample size suggest further study is warranted.
Min et al. (2026) studied this question.