Evaluation of Efficacy and Safety of Tibial‐Pedal Artery Access Using a Novel Articulating‐Tip Guidewire
Ashwani Sastry, Sreejit NairABSTRACT
Background
Retrograde tibial‐pedal access is a well‐established technique for managing peripheral arterial occlusive disease and its associated ischemic symptoms. While generally considered safe and effective, this method presents notable challenges due to the small caliber and, often, diseased nature of the target vessels, which can complicate entry and cannulation. As a result, multiple access attempts may be necessary, and access‐related complications can hinder or even prevent a successful percutaneous intervention.
Aims
This report aims to describe a single‐center experience utilizing a novel access guidewire featuring a small core diameter and an articulating tip to facilitate tibial‐pedal access.
Methods
Patients with peripheral vascular disease in whom tibial‐pedal access was attempted between January 2, 2024 and September 15, 2025 were included. Real‐time ultrasound guidance was used in all cases. Post‐procedural ultrasound was performed after hemostasis was achieved with manual compression to evaluate the accessed vessel patency and rule out complications. Study outcomes were first‐attempt and overall guidewire insertion success, post‐procedural and 30‐day patency of the accessed vessel on ultrasound, and incidence of access site complications.
Results
Records of 167 access procedures attempted in 133 patients were reviewed (left anterior tibial–76, right anterior tibial–71, right posterior tibial–7, left posterior tibial–4, left dorsalis pedis–1). First‐attempt success was 98% (154/157 evaluable records) and all‐attempt success was achieved in 100% of the cases. There were no access‐site complications, such as occlusion, extravasation, or pseudoaneurysm. Patency was confirmed in all accessed vessels immediately following the procedure and maintained in all but one case at the 30‐day mark.
Conclusions
Tibial‐pedal access was successfully obtained in all cases, demonstrating an exceptionally high nominal first‐attempt success rate and no peri‐procedural complications. In conjunction with preserved post‐procedural vessel patency, these findings support the articulating‐tip guidewire's safety and effectiveness for its intended application.