Successful Endovascular Treatment of Chronic Total Occlusion of Superficial Femoral Artery Using Retrograde Approach From Deep Femoral Artery

Nakamura, Yūichi; Komatsu, Nobuo; Masuda, Atsuro; Kunii, Hiroyuki; Takeda, Hiroto; Takeishi, Yasuchika

doi:10.5387/fms.2013-19

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…On the other hand, the SFA proximal noncalcified lesions of very heavy patients which cannot be detected through the surface ultrasound and fluoroscopy are not an indication for the PAPRICA technique. A recent report presented wire recanalization done at an in‐stent occlusion of the proximal SFA by direct retrograde puncture of the occluded stent 5 . In that case, they puncture the stent as a marker.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of the novel proximal superficial femoral artery puncture technique to recanalize chronic total occlusions

Fukagawa

Mori

Hirano

2020

Cathet Cardio Intervent

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Chronic total occlusion (CTO) of the superficial femoral artery (SFA) with flush occlusion is sometimes difficult to be treated by endovascular treatment (EVT). The guidewire could not pass the proximal cap because the entry of the CTO could not be detected by angiography. Thus, a retrograde approach is considered; however, there was a risk of jeopardizing the adjacent deep femoral artery by subintimal angioplasty. Moreover, the retrograde approach is not feasible when the distal artery could not be punctured because of stenosis, occlusion, or uncomfortable positioning for patients during EVT. Therefore, we considered a novel technique to overcome this problem, called the Proximal superficial femoral Artery Puncture to RecanalIze the Chronic totAl occlusion (PAPRICA) technique. In this technique, to establish wire externalization, a retrograde puncture was performed from the proximal site of the SFA‐CTO under ultrasound guidance, and the guidewire was advanced retrogradely from the puncture needle via the CTO site. After wire externalization, the guide catheter could be advanced into the SFA ostium. By pulling up the externalization wire, a strong backup and improved coaxial alignment of the guide catheter were achieved. This report presents two successful cases of flush SFA‐CTO using this novel technique.

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Section: Discussionmentioning

confidence: 99%

“…A recent report presented wire recanalization done at an in-stent occlusion of the proximal SFA by direct retrograde puncture of the occluded stent. 5 In that case, they puncture the stent as a marker. On the contrary, under ultrasound guidance, we can puncture at the proximal SFA site retrogradely with or without deploying a stent.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of the novel proximal superficial femoral artery puncture technique to recanalize chronic total occlusions

Fukagawa

Mori

Hirano

2020

Cathet Cardio Intervent

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“…For both direct puncture and collateral approaches, high success rates were reported. [16][17][18] The collateral approach has the advantage of omitting another puncture, but there are some drawbacks. It is difficult to control and push the retrograde guidewire and microcatheter via collateral, and if the collateral is damaged, which is the only feeder for the distal artery, the patient's leg condition could become more severe.…”

Section: Discussionmentioning

confidence: 99%

Popliteal Retrograde Approach is Effective and Safe for Superficial Femoral Artery Chronic Total Occlusion

Ueshima

Ashikaga

Shimura

et al. 2015

Annals of Vascular Diseases

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Objective: Endovascular treatment (EVT) using a popliteal approach is effective for superficial femoral artery (SFA) chronic total occlusion (CTO); however, its effectiveness, safety, and consequent complications are unclear. Materials and Methods:We studied 324 consecutive EVTs (in 187 patients) performed at three centers between April 2008 and March 2013, and selected all EVTs that included SFA CTO regions. A total of 91 EVTs (in 65 patients) were included and divided into two groups; "with popliteal approach" (WPA) and "without popliteal approach" (WOPA). Results: Despite higher rates of hypertension (WPA, 88.9% vs. WOPA, 69.1%; p = 0.04) and CTO length >200 mm (55.6% vs. 28.3%, respectively; p <0.01), the primary success rate was better in the WPA group (97.2% vs. 78.2%, respectively; p <0.01); however, both total complication rate and major complication rate were not significantly different. We compared popliteal puncture using a sheath and using a microcatheter alone. There were no significant differences between sheath and microcatheter use in terms of primary success rates (95.5% vs. 100%, respectively; p = 0.61) and puncture site complications (22.7% vs. 14.2%, respectively; p = 0.53). Conclusion: A popliteal approach improved the primary success rate of EVT for SFA CTO.Keywords: endovascular treatment, superficial femoral artery total occlusion, retrograde approach, popliteal puncture long, diffuse occlusions and/or long total occlusions, and it commonly requires endovascular treatment (EVT). 1) The primary success rate of EVT for SFA CTO has improved from 75% in 2001 2) to 81%-94% in 2014. 3) EVTs for SFA are generally managed by the antegrade approach, which uses a contralateral retrograde puncture or ipsilateral antegrade puncture of the common femoral artery. Alternatively, the popliteal approach is less frequently utilized. The popliteal approach, first reported by Tonnesen et al. 4) and initially performed with patients in a prone position, 5) has been associated with complications such as dissections, arterial ruptures, arteriovenous fistula, pseudoaneurysms, bleeding, and hematomas, 6,7) making it less popular than the antegrade approach. 8) Furthermore, to avoid changing a patient's position, popliteal puncture with patients lying in the supine position has been reported. 9) In addition, the use of lower-diameter puncture instruments, such as 3 Fr sheaths or microcatheters, instead of the conventional 4-6 Fr sheaths, has been attempted. 10,11) With the use of these modifying techniques, the aim is to reduce complications and the nuisance of popliteal puncture, and it has since gained popularity.This study investigates the effectiveness and safety of the popliteal retrograde approach for SFA CTO. We compared EVT with the popliteal approach and EVT without popliteal approach in terms of primary success rates and puncture site complications. Another purpose of this study was to clarify the type of complications occurring during EVT with and without the popliteal approach. Furthermore, we analyzed...

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“…The procedural success rates are improved with the use of a bidirectional approach. [4][5][6] A distal SFA direct puncture or distal SFA direct side puncture is problematic due to the risk of hemostasis, and sheath insertion is not possible. Furthermore, because the procedure cannot be applied to compression hemostasis, it is necessary to stop the bleeding by balloon expansion from inside the blood vessel.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Long Superficial Femoral Artery–Chronic Total Occlusions Using the Gogo Catheter With IVUS Via a Popliteal Puncture Method Is Effective, Safe, and Useful

Nakamura¹,

Rokutanda²,

Kurokawa³

et al. 2020

Vasc Endovascular Surg

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Objectives: We aimed to investigate the usefulness of inserting a 6Fr sheath guided by duplex ultrasonography via a popliteal artery puncture. We also aimed to demonstrate endoluminal tracking using a retrograde approach using the Gogo catheter with intravascular ultrasound (IVUS). Background: The bidirectional approach is useful for increasing the success rate of the procedure for long superficial femoral artery–chronic total occlusions (SFA-CTOs). However, this procedure becomes somewhat complicated. Since the proximal blood vessel diameter is clearly larger than the distal end of the CTO and the body surface duplex guide can also be used in the proximal part, it is easier to introduce a retrograde guidewire (GW) into the proximal end. Methods: We performed endovascular treatment for long SFA-CTOs with a Gogo catheter + IVUS guide in 31 consecutive cases (male 20/female 11; mean age, 75.6 ± 7.6) from May 2017 to November 2018. We advanced the IVUS until the true lumen could be confirmed and advanced the Gogo catheter toward the IVUS for reinforcement. We attempted to approach the long CTO by repeating this procedure. We named this procedure the GIP method (GIP: Gogo catheter with IVUS via a popliteal puncture). Hemostasis of the popliteal artery was achieved using a commercially available compression hemostatic kit (Tometa-kun, XEMEX, Japan). Results: Successful revascularization was achieved in all cases (in 2 cases, a femoral artery puncture was added, and a bidirectional approach was used, and in 1 case, a CROSSER system was used). On average, the fluoroscopy time was 42.2 ± 30.4 minutes, radiation dose 93.7 ± 78.7 mGy, and amount of contrast medium used 15.0 ± 9.6 mL. The procedure time was defined as from the start of the popliteal artery puncture to the time the GW passed through the CTO lesion, including the posture transformation time from prone to the supine position. The procedure time was 42.1 ± 40.2 minutes. There were no major adverse events or other major complications, such as a distal embolism, rupture of the CTO lesion, arteriovenous fistula, or major hematoma requiring a transfusion or surgical treatment. Only 2 small hematomas occurred at the popliteal artery puncture site. The patients were treated conservatively and were discharged as usual. Conclusions: Endovascular treatment of long SFA-CTOs via the popliteal approach was effective and safe. Using the GIP method to address long SFA-CTOs is recommended.

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Successful Endovascular Treatment of Chronic Total Occlusion of Superficial Femoral Artery Using Retrograde Approach From Deep Femoral Artery

Cited by 4 publications

References 7 publications

Feasibility of the novel proximal superficial femoral artery puncture technique to recanalize chronic total occlusions

Feasibility of the novel proximal superficial femoral artery puncture technique to recanalize chronic total occlusions

Popliteal Retrograde Approach is Effective and Safe for Superficial Femoral Artery Chronic Total Occlusion

Endovascular Treatment of Long Superficial Femoral Artery–Chronic Total Occlusions Using the Gogo Catheter With IVUS Via a Popliteal Puncture Method Is Effective, Safe, and Useful

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