scholarly journals Retrograde Popliteal Access for Challenging Superficial Femoral Artery Occlusion

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Georges Ibrahim ◽  
Sami Nabhani ◽  
Michel Feghaly
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Artery Occlusion ◽  
Complication Rates ◽  
Puncture Site ◽  
Safe Alternative ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Antegrade Approach ◽  
Arteriovenous Shunts

Retrograde popliteal access has long been established as an alternative to the antegrade approach to occlusive lesions in the superficial femoral artery (SFA). However, early reports with high complication rates (dissection, hematomas, aneurysms, and arteriovenous shunts at the puncture site) reduced enthusiasm for this technique. In recent years, with the development of thinner sheaths and low profile angioplasty devices, retrograde popliteal access has resurfaced as a viable technique, mostly in combination with or after failure of the more classical antegrade approach. In this retrospective study, we will report the safety and efficacy of the retrograde popliteal approach in the treatment of superficial femoral artery chronic total occlusions, in 13 consecutive patients between January 2017 and January 2021. The results showed 100% successful puncture of the popliteal artery and 100% successful recanalization and stenting of the superficial femoral artery with a total of 2 complications related to the puncture site and zero periprocedural mortality. In conclusion, the retrograde popliteal approach appears to be an effective and safe alternative to the common SFA complete total occlusion (CTO) treatment approach.

scholarly journals Guidelines adherence or chronic total occlusion recanalization of the superficial femoral artery with a stentless approach: The next frontier?

2019 ◽  
Vol 7 ◽  
pp. 2050313X1882344
Author(s):  
Christos Rammos ◽  
Tobias Radecke ◽  
Julia Lortz ◽  
Martin Steinmetz ◽  
Tienush Rassaf
Keyword(s):  
Intermittent Claudication ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Chronic Total Occlusion ◽  
Complication Rates ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Surgical Bypass ◽  
Guidelines Adherence

In patients with intermittent claudication and long chronic total occlusions of the superficial femoral artery, a primary surgical bypass or stenting is recommended. However, due to the invasive nature, high complication rates and patient-related comorbidities, surgery is currently not the preferred method and full lesion stenting for long chronic total occlusions has the obvious consequences of permanent metallic implants. We report a case of a patient with a long chronic total occlusion of the superficial femoral artery with intermittent claudication. Endorsing an endovascular-first strategy, he was treated via an antegrade and retrograde approach with a complete recanalization and a stentless treatment with rotational atherectomy and drug-coated balloons. We believe this is a feasible endovascular strategy for the treatment of long chronic total occlusions of the superficial femoral artery for patients refusing open surgery. Further investigations are needed to evaluate long-term clinical outcomes of these novel techniques.

scholarly journals Percutaneous Treatment of Superficial Femoral Artery Total Occlusions: Single Center Experience

Acta Medica ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 30-35
Author(s):  
AHMET HAKAN ATEŞ ◽  
AYSU BAŞAK ÖZBALCI ◽  
SELİM KUL ◽  
MUSTAFA YENERÇAĞ ◽  
Metin Okşul ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Treatment Strategy ◽  
Percutaneous Treatment ◽  
Arterial Disease ◽  
Complication Rates ◽  
Total Occlusion ◽  
First Choice ◽  
Stenting Procedure

Objectives Superficial femoral artery (SFA) is the most commonly effected vessel in peripheral arterial disease (PAD) and SFA total occlusions constitute the 50% of PAD patients presenting with symptoms. In this study, we investigated our patients with SFA total occlusions who were treated with percutaneous treatment strategy.   Methods In this study, we included ambulatory patients who were admitted to our clinics due to symptomatic severe SFA total occlusion and underwent PTA or PTA + stenting procedure.The demographic findings of the patients, procedure details, complications and follow-up results were noted. Results Out of 67 patients, 62 (92.5%) underwent PTA or PTA + stenting procedure successfully for SFA total occlusions. Only one serious complication, acute renal failure resulting in death developed during hospitalization. The mean follow-up time after the procedure was 11.1±7.2 months. During this follow-up time 36 (58.1%) were asymptomatic.  Out of 26 patients who were symptomatic, only 6 of them underwent reintervention and 3 were recommended surgical intervention.   Conclusion Peripheral interventions for SFA total occlusions are being performed successfully in experienced centers with low complication rates as the first treatment strategy in PAD. Herein,we have presented our patients who underwent successful PTA and/or stenting procedure with   high success and low complication rates. Peripheral interventions should be the first choice for SFA total occlusions in experienced centers.  

Preoperative assessment of computerized tomography angiography to predict success for crossing long Trans-Atlantic Inter-Society Consensus D lesions using the optical coherence tomography catheter

Vascular ◽  
2017 ◽  
Vol 26 (4) ◽  
pp. 362-367 ◽  
Author(s):  
Ryan J Kim ◽  
Jamie B Smith ◽  
Todd R Vogel
Keyword(s):  
Optical Coherence Tomography ◽  
Lower Extremity ◽  
Computerized Tomography ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Plaque Morphology ◽  
Optical Coherence ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Computerized Tomography Angiography

Objectives Optical coherence tomography chronic total occlusion catheter, the Ocelot (Avinger Inc., Redwood City, CA), has been utilized to cross Trans-Atlantic Inter-Society Consensus D lesions. This study evaluated the preoperative computerized tomography angiography of chronic total occlusions in the superficial femoral artery to predict clinical success. Methods We reviewed all patients who underwent lower extremity procedures with the Ocelot catheter from June 2014 to August 2016. Patients who had a preoperative computerized tomography angiography were evaluated. Final outcomes, plaque morphology, lesion length, calcium surface area, lesion location, and patient characteristics were analyzed. Results A total of 107 patients underwent lower extremity interventions with the Ocelot catheter. Seventy patients had a preoperative computerized tomography angiography scan prior to lower extremity intervention and 77% (54) had Trans-Atlantic Inter-Society Consensus D lesions that were crossed. Mean age was 62.8 years and 68.6% were male. Mean chronic total occlusion length was 182.7 mm (170.8 mm crossed vs. 222.6 mm uncrossed, p = 0.03). Calcium distribution differed significantly ( p<.01): circumferential (14.8 vs. 12.5%); eccentric (85 vs. 62.5%); and complete calcium occlusion (0 vs. 25%) for lesions that were crossed and uncrossed, respectively. Significant differences ( p<.0001) were found when calcium occlusion was less than 50% (87 vs. 31%), 51–75% (9.3 vs. 31.2%), and 76–100% (3.7 vs. 37.5%). Total calcium length in crossed lesion was 51.6 mm, and 92.8 mm in uncrossed lesions ( p = 0.10). No significant differences were noted for patient gender, occlusion location (proximal, middle, and distal superficial femoral artery), and kidney function. Conclusion The Ocelot catheter is an effective method to cross long Trans-Atlantic Inter-Society Consensus D lesions. Superficial femoral artery lesions longer than 17 cm and focal plaque morphology, specifically a total cross-sectional area of calcium and a calcium surface area greater than 50% were most predictive of failure to cross Trans-Atlantic Inter-Society Consensus D superficial femoral artery lesions. Computerized tomography angiography is an effective tool to predict success for crossing chronic total occlusions using optical coherence tomography technology and a critical consideration for patient selection.

scholarly journals A Combined Radial and Pedal Access to Treat a Flush Chronic Total Occlusion of the Superficial Femoral Artery in a Critical Limb Ischemia Patient

2019 ◽  
Vol 11 ◽  
pp. 117906521983452
Author(s):  
Nicolas W Shammas ◽  
Qais Radaideh
Keyword(s):  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Superficial Femoral Artery ◽  
Chronic Total Occlusion ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Retrograde Approach ◽  
Total Occlusion ◽  
Radial Approach ◽  
Antegrade Approach

We present a case of a flush chronic total occlusion of the superficial femoral artery treated successfully with a combined antegrade approach using radial access and a retrograde approach using a pedal access. Patient has total occlusion of the contralateral left external iliac and common femoral artery. Our case illustrates the feasibility of the combined pedal-radial approach in treating flush occlusions of the superficial femoral artery.

Scoring Balloon Reduces the Severity of Dissection and Stent Implantation Rate in Superficial Femoral Artery Angioplasty Compared to Plain Balloon

2020 ◽  
pp. 153857442096897
Author(s):  
Hanbee Hong ◽  
Ui Jun Park ◽  
Young Nam Roh ◽  
Hyoung Tae Kim
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Stent Implantation ◽  
Implantation Rate ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Total Occlusion ◽  
Scoring Balloon ◽  
Significant Difference ◽  
The Difference

Purpose: The knowledge regarding the benefits of the scoring balloon (SB) in comparison to the plain balloon (PB) is limited. This study aims to elucidate the difference in efficacy between SB and PB as pre-balloon in superficial femoral artery angioplasty. Methods: We retrospectively analyzed angiographic images of 113 lesions in 98 patients treated with endovascular surgery. 37 lesions were prepared by SB and 76 lesions by PB. Lesions without significant residual stenosis nor a flow-limiting dissection were treated by drug-coated balloon and the others by drug-eluting stent. Severity of dissection was evaluated by Kobayashi dissection grade and NHLBI classification. The rate of stent implantation was compared between the 2 groups. Kaplan-Meier analysis estimated freedom from target lesion revascularization (TLR) rate at 12 months. Results: Severe dissections (>1/3 of lumen) occurred less frequently in the SB group (SB 40.5% vs. PB 75.0%, P = 0.001). Overall stent implantation rate was lower in the SB group (SB 27.0% vs. PB 55.3%, P = 0.005). In subgroup analysis for the complex lesions, the SB group had lower rate of severe dissection(>1/3 of lumen) in patients with long lesions(>15 cm) (SB 51.7% vs. PB 76.9%, P = 0.020) and lesions of calcium grade ≥2 (SB 43.8% vs. PB 72.5%, P = 0.009). SB group had lower stent implantation rate in patients with long lesions (SB 34.5% vs. PB 59.6%, P = 0.030), lesions of calcium grade ≥2 (SB 31.3% vs. PB 56.9%, P = 0.023), and total occlusion (SB 30.8% vs. PB 80.0%, P = 0.002). There were no procedure-related complications in either group except 1 case of puncture-site hematoma. There was no significant difference in TLR rate between both groups at 12 months (P = 0.509). Conclusion: SB reduces the incidence of severe dissection (>1/3 of lumen) and rate of overall stent implantation in comparison with PB. The use of SB is a safe and effective method of lesion preparation in SFA angioplasty.

scholarly journals Endovascular therapy for severely calcified plaque at the superficial femoral artery using myocardial biopsy forceps

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Shojiro Hirano ◽  
Atsushi Funatsu ◽  
Shigeru Nakamura ◽  
Takanori Ikeda
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Calcium Score ◽  
Biopsy Forceps ◽  
Myocardial Biopsy ◽  
Deep Femoral Artery ◽  
Total Occlusion ◽  
Stent Expansion ◽  
Calcified Plaque ◽  
The Right

Abstract Background Currently, the success rate of EVT for treating CTO of the SFA is high; however, EVT is still found to be insufficient in treating CTOs with severely calcified lesions. Even if the guidewire crosses the lesion, the calcifications may still cause difficulties during stent expansion. Main text A 78-year-old male had been reported to have intermittent claudication with chronic total occlusion (CTO) of the right superficial femoral artery (SFA). Angiography revealed severely calcified plaque (Angiographic calcium score: Group4a [1]) at the ostium of the SFA. Stenting posed a risk of underexpansion, causing the plaque to shift to the deep femoral artery. we decided to remove the calcified plaque using biopsy forceps. After removing the extended calcified plaque, the guidewire could cross easily, and the self-expandable stent was well dilated without causing the plaque to shift to the DFA. Conclusions Biopsy forceps may be used in some endovascular cases to remove severely calcified lesions. To ensure the safety of the patient, the physician must be adept at performing this technique before attempting it.

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