Retrograde access via the popliteal artery to facilitate the re‐entry technique for recalcitrant superficial femoral artery Chronic total occlusions

Abstract

Subintimal recanalization is beneficial in selected patients with peripheral chronic total occlusions (CTO). However, in complex cases, re-entry into the true arterial lumen may prove to be unsuccessful with a conventional guidewire or a re-entry catheter when using standard femoral artery access. Our case series describes these technical dilemmas along with strategies that can be utilized to overcome these challenges.

Novel devices and specialized techniques in recanalization of peripheral artery chronic total occlusions (CTOs) — A literature review

“…In some selective cases the combination of these techniques can be utilized. Pappy et al [50] reported 4 successful cases using Outback and Pioneer catheters when the conventional guidewire technique was not successful in achieving re-entry into the true arterial lumen by retrograde transpopliteal access. Endovascular revascularization has become the first line treatment in peripheral CTOs with the novel assist devices and techniques.…”

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

“…The main indications for this technique are a short SFA stump, flush occlusion or tandem CFA/SFA lesions, and failure of the antegrade approach (3,7). It has been postulated that recanalization may be more successful given the less severely fibrotic/calcified thrombus when approached from the distal end (2).…”

Commentary: IVUS-Guided Recanalization of Peripheral CTOs: No More Eyes Wide Shut for Physicians?

“…In order to recanalize a CTO lesion in the femoropopliteal district, the most utilized methods are the subintimal technique, 7,8 the bidirectional subintimal angioplasty via popliteal artery approach, 9,10 and the duplex-guided technique. 5,6 In this setting, exploitation of the subintimal plane in crossing complex lesions and occlusions has emerged as a relatively easy technique to achieve limb recanalization.…”

“…4 To improve success, novel devices and ingenious approaches have been developed to assist the operator in CTO recanalization. In this setting, utilization of duplex-guided procedures 5,6 and translation of coronary CTO recanalization techniques, such as subintimal and true lumen reentry angioplasty 7,8 or retrograde approaches, 9,10 have increased the success rate of this procedure in the peripheral districts.…”