Percutaneous popliteal approach for angioplasty of superficial femoral artery occlusions

Abstract

Angioplasty using the percutaneous popliteal approach was utilized in 50 patients (PTS) to recanalize 59 occluded superficial femoral arteries which had been unsuccessfully canalized by using the antegrade approach because of either a flush origin occlusion or inability to maintain the guide wire in the true lumen. All PTS had claudication; 8 had rest pain; 3 had non-healing ulcers. The laser Probe was used in 17 cases and the Rotablator in 3 cases. Occlusion length varied between 1 and 40 cm: 7 lesions were less than 10 cm (group 1); 9 were between 10 and 20 cm (group 2); and 43 were greater than 20 cm (group 3). An angiographic success was obtained in 48/59 lesions (81%): 14/16 (87%) in groups 1 and 2 and 34/43 (79%) in group 3. Three PTS needed complementary common femoral endarterectomy and one required percutaneous aspiration of a thromboembolus. Complications included: arterial perforation and/or dissection (without clinical sequelae) in 11 and a popliteal hematoma in 1 PT. One patient with a severely ischemic leg underwent successful emergency vascular surgery, while another limb salvage patient required below-knee amputation. There was no worsening of limb ischemia from any popliteal approach attempt. At discharge, 39 patients (78%) whose outcome would have been unsuccessful with the traditional antegrade approach were clinically improved after utilizing the popliteal approach to achieve a successful angioplasty procedure.

Five-year retrograde transpopliteal angioplasty results compared with antegrade angioplasty

“…13 To date, outcomes have only been published from consecutive PA series or case reports with no direct comparisons to FA and long-term PA outcomes not specifically assessed. [1][2][3][4][5][6]11,13 PA is used in a significant proportion (24.2%) of our total angioplasties and this study presents our experience of the technique. In an attempt to minimise experimental bias within this retrospective study, all PA and FA performed within the research period were analysed.…”

Puncture of the popliteal artery using a Doppler-equipped (SMART) needle in transpopliteal interventions

“…This approach is not suited for all patients: combined iliac and femoral lesions [1,2,3,4,5,6,7], an occlusion or a high takeoff of the origin of the superficial femoral artery (SFA) [3,5], or severe obesity limits or precludes the transfemoral approach. A graft prosthesis in the groin raises the risk of complications [8,9].…”

Urokinase infusion of chronically occluded femoropopliteal gortex™ bypass grafts via the popliteal approach

“…2a) was advanced into the femoropopliteal graft and, subsequently, into the common femoral artery [2]. A 5F multipurpose infusion catheter was advanced over the guidewire to the level of the proximal anastomosis.…”

“…The posterior popliteal artery wall was punctured. A 5F arterial sheath was placed using published techniques [2]. Heparin (5,000 units) was given.…”