An innovative modification of the retrograde approach to angioplasty and recanalization of the superficial femoral artery

H’ng, Martin Weng Chin; Punamiya, Sundeep

doi:10.5152/dir.2013.13330

Cited by 9 publications

(8 citation statements)

References 8 publications

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“…Distal SFA is usable only when the femoral‐popliteal tract is not part of the target lesion. The popliteal approach necessitates repositioning in a prone position, with an increased risk of sheath dislodgement, hematoma, and neurologic access site complications 40–42 . The pedal artery requires the use of low‐profile devices 43 .…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of femoro‐popliteal occlusions with retrograde tibial access after failure of the antegrade approach

Minici

Serra

Rosi

et al. 2023

Cathet Cardio Intervent

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Background: Despite the development in endovascular technologies and the introduction of new tools in clinical practice, the endovascular crossing of femoropopliteal occlusions is not always possible with the antegrade approach, with a failure rate that can be up to 20%. This study aims to assess the feasibility, safety, and efficacy in terms of acute outcome of the endovascular retrograde crossing of femoro-popliteal occlusions with tibial access.Methods: This study is a single-centre, retrospective analysis of prospectively collected data of 152 consecutive patients, who had undergone, from September 2015 to September 2022, endovascular treatment of femoro-popliteal arterial occlusions with retrograde tibial access after the failure of the antegrade approach.Results: The median lesion length was 25 cm and 66 patients (43.4%) had a calcium grading according to the peripheral arterial calcium scoring system of 4. Angiographically, 44.7% of the lesions were TASC II category D. In all cases, successful cannulation and sheath introduction were performed with an average cannulation time of 150.4 s. Femoropopliteal occlusions were successfully crossed with the retrograde route in 94.1% of cases; the intimal approach was performed in 114 patients (79.7%). The mean time from puncture to retrograde crossing was 20.5 min. Acute vascular access-site complications were noted in 7 (4.6%) patients.Thirty-day major adverse cardiovascular events rate and 30-day major adverse limb events rate of 3.3% and 2%, respectively, were observed. Conclusions:The results of our study indicate that retrograde crossing of femoropopliteal occlusions with tibial access is a feasible, effective, and safe approach in case of failed antegrade approach. The results presented represent one of the

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Section: Discussionmentioning

confidence: 99%

Endovascular treatment of femoro‐popliteal occlusions with retrograde tibial access after failure of the antegrade approach

Minici

Serra

Rosi

et al. 2023

Cathet Cardio Intervent

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“…Montero-Baker et al reported that the failure rate of antegrade recanalization can reach up to 20% in CTO lesions in lower limb arteries [8]. Difficulties in crossing the occlusion are related to the morphology of the plaque as CTOs are harder, more fibrous within the proximal cap, and with diffuse calcification [9–11]. For retrograde puncture, there are a few arteries that can be chosen: the distal segment of the SFA, PA, tibial artery, and pedal artery.…”

Section: Discussionmentioning

confidence: 99%

Predictors of mortality and outcomes after retrograde endovascular angioplasty in patients with peripheral artery disease

Kleczyński

Ruzsa

Wojtasik-Bakalarz

et al. 2019

pwki

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Introduction Endovascular revascularization (ER) techniques in patients with peripheral artery disease (PAD) have been developed and became more accessible in recent years. The ER is a first-line treatment in the majority of patients with symptomatic PAD. However, data on assessment of predictors of long-term outcomes of retrograde ER in patients with PAD are scarce. Aim To evaluate predictors of long-term outcomes of retrograde ER in patients with chronic total occlusion in lower limb arteries. Material and methods We analyzed data of 834 patients who underwent retrograde ER. Baseline clinical characteristics and procedural data were collected. Patients were followed up for 36 months, and the primary endpoint was all-cause mortality. Results All patients were symptomatic and had failed antegrade ER. The procedural success rate was 92%. Cumulative all-cause mortality was 13.4% at 36-month follow-up. In multivariate analysis history of stroke, Rutherford category, chronic limb ischemia, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD) and previous ER of other lesion were independent predictors of a higher mortality rate after 36 months (hazard ratio (HR) for stroke 2.4, 95% confidence interval (CI): 1.55–3.66; p = 0.0002; HR for age per 10 years 1.37, 95% CI: 1.15–1.64; p = 0.0002; HR for Rutherford category 1.63, 95% CI: 1.35–1.98; p < 0.0001, HR for chronic limb ischemia 0.44, 95% CI: 0.25–0.8, p = 0.007; HR for CKD 1.73, 95% CI: 1.14–2.56, p = 0.01; HR for COPD 2.4, 95% CI: 1.5–3.7, p = 0.0004; HR for previous ER 0.59, 95% CI: 0.35–0.94, p = 0.02). Conclusions History of stroke, Rutherford category, chronic limb ischemia, CKD, COPD, and previous ER of other lesion were independently associated with increased risk of all-cause death.

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“…The structure of the lesion can determine the success of recanalization. A harder, calcified part in the proximal section and softer in the distal section may be more successful in transluminal intervention of CTOs by the retrograde approach [14–16]. …”

Section: Discussionmentioning

confidence: 99%

“…This maneuver could result in dislocation of the femoral sheath, prolongation of the procedure or deterioration of respiratory function [13, 14, 16]. Modifications to the method allow one position of the patient to be maintained and complications associated with the procedure to be reduced [14, 17–19]. …”

Section: Discussionmentioning

confidence: 99%

Twelve months follow-up after retrograde recanalization of superficial femoral artery chronic total occlusion

Wojtasik-Bakalarz¹,

Arif²,

Chyrchel³

et al. 2017

pwki

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IntroductionFifty percent of cases of peripheral artery disease are caused by chronic total occlusion (CTO) of the superficial femoral artery (SFA). Ten–fifteen percent of percutaneous SFA recanalization procedures are unsuccessful. In those cases the retrograde technique can increase the success rate of the procedure, but the long-term follow-up of such procedures is still unknown.AimTo assess the efficacy and clinical outcomes during long-term follow-up after retrograde recanalization of the SFA.Material and methodsWe included patients after at least one unsuccessful percutaneous antegrade recanalization of the SFA. Patients were evaluated for the procedural and clinical follow-up of mean time 13.9 months.ResultsThe study included 17 patients (7 females, 10 males) who underwent percutaneous retrograde recanalization of the SFA from June 2011 to June 2015. The mean age of patients was 63 ±7 years. Retrograde puncture of the distal SFA was successful in all cases. A retrograde procedure was performed immediately after antegrade failure in 4 (23.5%) patients and after a previously failed attempt in 13 (76.5%) patients. The procedure was successful in 15 (88.2%) patients, and unsuccessful in 2 (11.8%) patients. Periprocedural complications included 1 peripheral distal embolization (successfully treated with aspiration thrombectomy), 1 bleeding event from the puncture site and 7 puncture site hematomas. During follow-up the all-cause mortality rate was 5.8% (1 patient, non-cardiac death). The primary patency rate at 12 months was 88.2% and secondary patency 100%.ConclusionsThe retrograde SFA puncture seems to be a safe and successful technique for CTO recanalization and is associated with a low rate of perioperative and long-term follow-up complications.

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An innovative modification of the retrograde approach to angioplasty and recanalization of the superficial femoral artery

Cited by 9 publications

References 8 publications

Endovascular treatment of femoro‐popliteal occlusions with retrograde tibial access after failure of the antegrade approach

Endovascular treatment of femoro‐popliteal occlusions with retrograde tibial access after failure of the antegrade approach

Predictors of mortality and outcomes after retrograde endovascular angioplasty in patients with peripheral artery disease

Twelve months follow-up after retrograde recanalization of superficial femoral artery chronic total occlusion

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