Retrograde Transpopliteal Recanalization of Chronic Superficial Femoral Artery Occlusion after Failed Re-Entry during Antegrade Subintimal Angioplasty

Purpose: To evaluate the acute success and clinical impact of retrograde transpopliteal access for subintimal recanalization of superficial femoral artery (SFA) and proximal popliteal artery (PA) occlusions after failed attempts to re-enter the true lumen in the antegrade femoral approach. Methods:...

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Bibliographic Details
Published in:Journal of endovascular therapy 2009-10, Vol.16 (5), p.619-623
Main Authors: Noory, Elias, Rastan, Aljoscha, Schwarzwälder, Uwe, Sixt, Sebastian, Beschorner, Ulrich, Bürgelin, Karlheinz, Neumann, Franz-Josef, Zeller, Thomas
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Angioplasty
Angioplasty, Balloon - adverse effects
Angioplasty, Balloon - instrumentation
Arterial Occlusive Diseases - diagnostic imaging
Arterial Occlusive Diseases - therapy
Atherectomy - instrumentation
Constriction, Pathologic
Failure
Female
Femoral Artery - diagnostic imaging
Heart surgery
Humans
Hypothesis testing
Independent sample
Lasers, Excimer
Male
Medical imaging
Middle Aged
Patients
Popliteal Artery - diagnostic imaging
Prone Position
Prospective Studies
Radiography, Interventional
Recurrence
Registries
Severity of Illness Index
Software packages
Stents
Treatment Outcome
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Summary:Purpose: To evaluate the acute success and clinical impact of retrograde transpopliteal access for subintimal recanalization of superficial femoral artery (SFA) and proximal popliteal artery (PA) occlusions after failed attempts to re-enter the true lumen in the antegrade femoral approach. Methods: From 2002 to 2007, 56 patients (43 men; mean age 68±9 years, range 43–87) with stable chronic peripheral artery disease (Rutherford category 2 to 5) were treated with antegrade subintimal angioplasty that could not be completed owing to re-entry failure. Mean occlusion length was 17±7 cm (range 4–32), including 13 TASC II A (23.2%), 10 TASC II B (17.8%), 16 TASC II C (28.5%), and 17 TASC II D (30.3%) lesions. After re-entry to the true lumen failed in the antegrade approach, including predilation of the false channel, all patients were turned to a prone position, and a 5-F or 6-F sheath was placed into the mid segment of the PA under fluoroscopic guidance. Retrograde wire passage was attempted with a 0.035-inch hydrophilic guidewire. Results: Fifty-five (98.2%) of 56 procedures were finished successfully with a residual stenosis of
ISSN:1526-6028
1545-1550
DOI:10.1583/09-2784.1