Percutaneous laser hot‐tip recanalization of totally occluded superficial femoral arteries has previously been dependent on access to the superficial femoral artery via the common femoral artery. Certain subsets of disease do not permit this approach and thus make patients ineligible for this nonsurgical option. In order to extend the benefits of laser angioplasty to these patients, we have investigated the applicability of percutaneous popliteal artery puncture as an access point from which superficial femoral artery percutaneous laser balloon angioplasty can be performed. Twenty‐one procedures were performed on 20 patients with total superficial femoral artery occlusions. Eighteen had successful recanalization (85%). All 18 recanalized vessels were patent at 3 weeks post procedure. Minor complications which did not require surgical or medical intervention occurred in nine patients. We concluded that a percutaneous popliteal approach to laser angioplasty of a totally occluded superficial femoral artery can be safe and effective in selected patients.
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