Endovascular Approach to Combined Ipsilateral Supra-inguinal and Infra-inguinal Artery Stenosis through a Single Common Puncture in a Single Sitting: Technique and Follow-Up

Abstract

Background: Significant stenosis in both supra-inguinal and infra-inguinal arteries can be seen in a single given patient. When both are diseased, crossover technique from opposite femoral arteries or upper limb approach is the preferred technique. However, lot of anatomical factors can affect reaching the area from opposite femoral artery or upper limb. The purpose of this study is to determine the safety, efficacy, mid-term clinical and radiological outcome of the endovascular treatment using retrograde and antegrade femoral artery approach in those patients who have significant stenosis of both supra and infra inguinal arteries, from a single ipsilateral common femoral artery puncture. Materials and Methods: Between 2015 and 2017, we performed angioplasty to lower limb arteries for 73 patients at our centre. Among them 17 patients had significant stenosis of ipsilateral supra and infra-inguinal arteries. 12 patients underwent ipsilateral retrograde femoral artery puncture to access iliac arteries under fluoroscopy guidance, followed by converting the same puncture into antegrade approach to tackle superficial femoral artery or popliteal artery. Rest of the 5 patients, had alternative approaches (left upper limb or contralateral femoral artery) because of the involvement of ipsilateral femoral artery at the puncture site. Results: Acute success rate was 100%. There were no significant peri-procedure complications. At the latest clinical follow-up (mean of 21.25 months), a restenosis rate of 16.67% in infra-inguinal arteries and none in supra-inguinal arteries. Conclusion: Percutaneous retrograde femoral artery puncture and converting the same puncture into antegrade approach, to high-grade combined ipsilateral supra-inguinal and infra-inguinal artery stenosis is a viable, reasonably safer, one of the options to contralateral cross over or upper limb approach, with good midterm clinical results and patency rates.

Endovascular interventions to superficial femoral artery occlusion: Different approaches, technique, and follow-up

“…Hardware support, maneuverability is better, length to be transgressed is lesser, suitable irrespective of the aortoiliac bifurcation anatomy. We, in fact, used this approach even for combined suprainguinal and infrainguinal artery involvement if CFA puncture site is spared[ 10 ] [ Figure 3 ].…”

“…In ipsilateral suprainguinal and infrainguinal artery combined group [ Figure 2a ], if CFA puncture site and proximal 5 cm of the SFA is disease free, we used single common ipsilateral CFA [ Figure 3 ] puncture. [ 10 ] Using retrograde femoral artery approach, 7F femoral artery sheath was inserted. Through retrograde CFA sheath, initially iliac artery lesions were addressed in all 12 patients with stent implantation [Figure 3a - c ].…”