Evaluation of Ipsilateral Antegrade Techniques for Endovascular Treatment of Ostial Superficial Femoral Artery Lesions

Abstract

Background:The most prevalent cause of intermittent claudication is peripheral arterial disease (PAD) of the superficial femoral artery (SFA).The SFA is a target of atherosclerotic disease predominantly in the distal section in the region of Hunter's canal where the adductor muscles tend to compress the artery and in the proximal section near the bifurcation to the deep femoral artery. Aim of the study: In patients with persistent lower limb ischemia, to determine the feasibility, adequacy, safety, and consequences of an ipsilateral antegrade approach in the event of superficial femoral artery ostial lesions. Patients and Methods: Between August 2019 and August 2021, 30 patients with peripheral arterial occlusive disease were included in this prospective cohort research at Al-Azhar University Hospitals (Al-Hussain and Bab-Alsheryah) (affecting ostium of the superficial femoral artery). Results: The most frequent extension of the lesion was SFA CTO total length till the adductor canal (36.7%), followed by proximal 1/3 SFA tight stenosis extending into middle 1/3 of SFA (26.7%), proximal SFA CTO extending into middle 1/3 of SFA (20%), and proximal 1/3 SFA tight stenosis (16.7%). Most patients showed technical success (80%), and most of them (79.2%) had endo-luminal wire passage. The most frequent type of passage in failure cases was contralateral antegrade (50%), followed by trans brachial antegrade (33.3%) and popliteal ipsilateral retrograde (16.7%). Conclusion: Endovascular therapy (EVT) in ostial and near ostial SFA occlusive lesions with ipsilateral antegrade access through common femoral artery puncture is a feasible and effective approach.