A Review of Surgically Treated Patients with Obstruction after Stenting in the Femoropopliteal Artery Region

Shibuya, Takashi; Satō, Takashi; Edogawa, Seiji; Satoh, Hisashi

doi:10.7133/jca.52.19

Cited by 1 publication

(1 citation statement)

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“…However, when we performed unidirectional sub-intimal intervention, if the guidewire did not re-enter the intraluminal lumen of the artery at the distal end of CTO, we could broaden the length to treat; placement of stents in the common femoral artery and popliteal arteries should be avoided. 14) We believe that a bidirectional approach is particularly important in Japan where a re-entry device is not available for sub-intimal intervention. The effectiveness of the popliteal retrograde approach was previously confirmed for percutaneous coronary intervention (PCI).…”

Section: Discussionmentioning

confidence: 99%

Popliteal Retrograde Approach is Effective and Safe for Superficial Femoral Artery Chronic Total Occlusion

Ueshima

Ashikaga

Shimura

et al. 2015

Annals of Vascular Diseases

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Objective: Endovascular treatment (EVT) using a popliteal approach is effective for superficial femoral artery (SFA) chronic total occlusion (CTO); however, its effectiveness, safety, and consequent complications are unclear. Materials and Methods:We studied 324 consecutive EVTs (in 187 patients) performed at three centers between April 2008 and March 2013, and selected all EVTs that included SFA CTO regions. A total of 91 EVTs (in 65 patients) were included and divided into two groups; "with popliteal approach" (WPA) and "without popliteal approach" (WOPA). Results: Despite higher rates of hypertension (WPA, 88.9% vs. WOPA, 69.1%; p = 0.04) and CTO length >200 mm (55.6% vs. 28.3%, respectively; p <0.01), the primary success rate was better in the WPA group (97.2% vs. 78.2%, respectively; p <0.01); however, both total complication rate and major complication rate were not significantly different. We compared popliteal puncture using a sheath and using a microcatheter alone. There were no significant differences between sheath and microcatheter use in terms of primary success rates (95.5% vs. 100%, respectively; p = 0.61) and puncture site complications (22.7% vs. 14.2%, respectively; p = 0.53). Conclusion: A popliteal approach improved the primary success rate of EVT for SFA CTO.Keywords: endovascular treatment, superficial femoral artery total occlusion, retrograde approach, popliteal puncture long, diffuse occlusions and/or long total occlusions, and it commonly requires endovascular treatment (EVT). 1) The primary success rate of EVT for SFA CTO has improved from 75% in 2001 2) to 81%-94% in 2014. 3) EVTs for SFA are generally managed by the antegrade approach, which uses a contralateral retrograde puncture or ipsilateral antegrade puncture of the common femoral artery. Alternatively, the popliteal approach is less frequently utilized. The popliteal approach, first reported by Tonnesen et al. 4) and initially performed with patients in a prone position, 5) has been associated with complications such as dissections, arterial ruptures, arteriovenous fistula, pseudoaneurysms, bleeding, and hematomas, 6,7) making it less popular than the antegrade approach. 8) Furthermore, to avoid changing a patient's position, popliteal puncture with patients lying in the supine position has been reported. 9) In addition, the use of lower-diameter puncture instruments, such as 3 Fr sheaths or microcatheters, instead of the conventional 4-6 Fr sheaths, has been attempted. 10,11) With the use of these modifying techniques, the aim is to reduce complications and the nuisance of popliteal puncture, and it has since gained popularity.This study investigates the effectiveness and safety of the popliteal retrograde approach for SFA CTO. We compared EVT with the popliteal approach and EVT without popliteal approach in terms of primary success rates and puncture site complications. Another purpose of this study was to clarify the type of complications occurring during EVT with and without the popliteal approach. Furthermore, we analyzed...

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Section: Discussionmentioning

confidence: 99%