June 25, 2012 — Clinical investigators are for the first time examining the retrograde tibiopedal interventional approach, an endovascular technique that has the potential to reduce the rate of leg amputations by as much as 50 percent in patients with critical limb ischemia (CLI), a manifestation of peripheral arterial disease (PAD). Cook Medical, a company that specializes in interventional medical device technologies, is sponsoring the Tibiopedal Access for Crossing Infrainguinal Artery Occlusions study.
With the retrograde tibiopedal approach, a physician gains vascular access at the foot and advances wire guides and catheters up the leg to reach and cross arterial blockages. Individuals and single centers have reported initial success with the technique, which is often tried after a traditional antegrade approach fails. This is the first prospective, multi-center study to collect data on this technique.
An estimated 27 million people in Europe and North America suffer from PAD, which can lead to CLI, a severe obstruction of the arteries that decreases blood flow to the extremities, producing pain and skin ulcers or sores. CLI, which affects up to 300,000 people a year in the United States, is the end stage of lower-extremity PAD and poses a significant risk for limb loss. Currently, 25 percent of CLI patients undergo amputation as a primary treatment. Within two years of treatment, 25 percent of these patients die and another 30 percent experience additional lower-limb amputation. The mortality rate at five years following amputation can be as high as 68 percent.
Twelve sites in the United States and Europe will participate in the Tibiopedal Access for Crossing Infrainguinal Artery Occlusions study led by global principal investigator, Craig Walker, M.D., founder, president and medical director of the Cardiovascular Institute of the South in Louisiana. Up to 200 patients with a totally occluded lower-limb artery will be enrolled, and physicians will assess the technical success rates of the new procedure both for gaining vascular access via the foot and for crossing the lesion. Patient follow-up will consist of a telephone interview approximately 30 days after the procedure. J.A. Mustapha, M.D., director of endovascular intervention at Metro Health Hospital, has enrolled and treated the first patients in this study. Walker and Mustapha are compensated by Cook Medical for educational lectures they present to physicians on the tibiopedal access procedure.
For more information: www.cookmedical.com
May 06, 2026 
