Retrograde popliteal access as bail‐out strategy for challenging occlusions of the superficial femoral artery: A multicenter registry

Sangiorgi, Giuseppe; Lauria, Giulia; Airoldi, Flavio; Godino, Cosmo; Politi, Luigi; Colombo, Antonio; Clerici, Giacomo; Modena, Maria Grazia; Biondi‐Zoccai, Giuseppe

doi:10.1002/ccd.23361

Cited by 32 publications

(26 citation statements)

References 24 publications

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“…In 2 studies of retrograde revascularizations, Sheinert et al and Hua et al also demonstrated that a retrograde approach was safe. 3,4 Our procedural success rate of 94% compares favorably with a study by Sangiorgi et al 7 of 23 patients (25 limbs) requiring retrograde popliteal access for occlusive lesions with an average length of 20.6 ± 8.8 cm. This group demonstrated procedural success in 22 of 23 patients.…”

Section: Discussionsupporting

confidence: 79%

Retrograde Transpopliteal Access Is Safe and Effective—It Should Be Added to the Vascular Surgeon's Portfolio

Younes

El-Sayed

2015

Annals of Vascular Surgery

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Section: Discussionsupporting

confidence: 79%

Retrograde Transpopliteal Access Is Safe and Effective—It Should Be Added to the Vascular Surgeon's Portfolio

Younes

El-Sayed

2015

Annals of Vascular Surgery

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“…[16][17][18][19] With the evolving use of new therapeutic strategies, there are currently better options to improve both acute and long-term patient outcomes. 16,[20][21][22][23] Interwoven nitinol stents, due to their high radial force and flexibility, have also helped to overcome many of the disadvantages associated with selfexpanding bare-metal nitinol stents. [24][25][26][27] However, certain procedural limitations associated with stent placement, such as the need for meticulous vessel preparation and careful stent diameter selection, continue to exist.…”

Section: Discussionmentioning

confidence: 99%

Adjunctive stent use during endovascular intervention to the femoropopliteal artery with drug coated balloons: Insights from the XLPAD registry

et al. 2018

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With growing use of drug-coated balloons (DCB) for femoropopliteal (FP) artery interventions, there is limited information on rates of real-world adjunctive stent use and its association with short and long-term outcomes. We report on 225 DCB treated FP lesions in 224 patients from the Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851) between 2014 and 2016. Cochran-Mantel-Haenszel and Wilcoxon rank sum statistics were used to compare stented (planned or 'bail-out') versus non-stented DCB treated lesions. Stents were implanted in 31% of FP DCB interventions. Among the 70 stents implanted, 46% were for 'bail-out' indications and 54% were planned. Lesions treated with stents were longer (mean 150 mm vs 100 mm; p < 0.001) and less likely to be in-stent restenosis lesions (10% vs 28%; p=0.003). Stenting was significantly more frequent in complex FP lesions, including chronic total occlusions (66% vs 34%; p < 0.001). For bail-out stenting, interwoven nitinol stents were the most common type (50%) followed by drug-eluting stents (34%) and bare-metal stents (22%). There were no differences in peri-procedural complication rates or 12-month target limb revascularization rates (18.6% vs 11.6%; p=0.162) or 12-month amputation rates (11.4% vs 11%; p=0.92) between lesions where adjunctive stenting was used versus lesions without adjunctive stenting, respectively. In conclusion, in a contemporary 'real-world' adjudicated multicenter US registry, adjunctive stenting was necessary in nearly a third of the lesions, primarily for the treatment of more complex FP lesions, with similar short and intermediate-term clinical outcomes compared with non-stented lesions. ClinicalTrials.gov Identifier: NCT01904851.

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“… 23 The popliteal approach was more often used for occlusions than for stenosis in these patients. Sangiorgi et al 24 report technical success rates of nearly 96% in long TASC C and D lesions and propose the transpopliteal access as a safe and effective alternative when antegrade recanalization attempts have failed.…”

Section: Discussionmentioning

confidence: 99%

Transpopliteal Balloon-Assisted Excimer–Laser Atherectomy for the Treatment of Chronic Femoropopliteal Occlusions: Feasibility and Initial Results

Lüdtke

Scheer

Kamusella

et al. 2014

Clin Med Insights Cardiol

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PURPOSERecanalization of chronic total occlusions (CTOs) of the femoropopliteal arteries depends on a successful lesion crossing with the guide wire. The aim of this retrospective study was to evaluate the safety, feasibility, and the primary results of retrograde recanalization of CTOs with balloon-assisted excimer–laser atherectomy (ELA) via a transpopliteal approach after failed antegrade attempts.METHODSA total number of 15 patients (10 male, 5 female) with a mean age of 68.5 years (range: 43–91 years) treated with retrograde transpopliteal ELA in the years 2009–2012 were included retrospectively. After unsuccessful antegrade recanalization attempts with conventional guide wires and catheters, patients were treated with a retrograde recanalization attempt via a transpopliteal access using an excimer laser, followed by pressure-only balloon angioplasty (POBA). The mean length of the CTOs in the femoropopliteal arteries was 17.8 ± 5.4 cm (range: 9–29 cm).RESULTSTechnically successful recanalization was achieved in 14 of 15 patients. Provisional stenting was done in two cases. There were no major adverse events regarding the laser atherectomy or popliteal access site. One acute reocclusion was observed in the first 48 hours after intervention. The ankle-brachial Index increased from preinterventional 0.45 ± 0.07 to 0.77 ± 0.29 (P < 0.05) in the follow-up period (1.5 months), resulting in a primary patency of 80%.CONCLUSIONThe retrograde ELA for recanalization of chronic femoropopliteal occlusions via a popliteal access turned out to be a safe and effective procedure with promising primary results. Thus it may be an endovascular treatment option for long chronic occlusions after failed antegrade recanalization or in patients who are not suitable for surgery.

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Retrograde popliteal access as bail‐out strategy for challenging occlusions of the superficial femoral artery: A multicenter registry

Abstract: Whenever standard access sites do not enable successful recanalization of SFA occlusions, retrograde popliteal access can be safely and effectively envisioned as bail-out strategy.

Cited by 32 publications

References 24 publications

Retrograde Transpopliteal Access Is Safe and Effective—It Should Be Added to the Vascular Surgeon's Portfolio

Retrograde Transpopliteal Access Is Safe and Effective—It Should Be Added to the Vascular Surgeon's Portfolio

Adjunctive stent use during endovascular intervention to the femoropopliteal artery with drug coated balloons: Insights from the XLPAD registry

Transpopliteal Balloon-Assisted Excimer–Laser Atherectomy for the Treatment of Chronic Femoropopliteal Occlusions: Feasibility and Initial Results

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