Document Detail

Retrograde recanalization technique for use after failed antegrade angioplasty in chronic femoral artery occlusions.
MedLine Citation:
PMID:  22313197     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To describe a technique to approach chronic total occlusions (CTOs) of the superficial femoral artery (SFA) after failed antegrade recanalization as an alternative to a conventional transpopliteal approach.
METHODS: A retrospective analysis was undertaken of 50 patients (37 men; mean age 71 years) who underwent retrograde recanalization via a distal SFA access after failed antegrade recanalization of SFA CTOs that were not beyond the adductor canal. Antegrade recanalization failed due to flush SFA occlusion, occluded stents, wire perforation, and re-entry failure. Retrograde SFA access required introduction of a 7- to 15-cm, 21-G needle distal to the occlusion. A 0.018-inch guidewire was inserted through the needle followed by a 4- or 6-F, 10-cm sheath or dedicated support catheter only. All retrograde SFA punctures were performed with the patient in the supine position. Once retrograde passage of the occlusion was successful, oftentimes requiring a "double-balloon" technique to disrupt the dissection membrane with abutting balloons delivered from both access sites, balloon angioplasty and/or stenting could be performed from either direction.
RESULTS: Retrograde puncture of the distal SFA was successful in all cases. Retrograde recanalization involved insertion of a 6-F sheath in 3 (6%) cases, a 4-F sheath in 32 (64%), and a sheathless approach in 15 (30%). The "double-balloon" technique was necessary to achieve guidewire passage in 12 cases. Recanalization was successful in 48 (96%) cases. Hemostasis time at the distal puncture site was 9.2 minutes (range 3-30). Perioperative complications included 4 pseudoaneurysms (2 groins, 2 distal), 1 peripheral embolization, and 1 small arteriovenous fistula at the distal puncture site.
CONCLUSION: For failure of antegrade recanalization of SFA occlusions, the retrograde SFA puncture distal to the adductor canal with the patient remaining supine is a safe and successful technique that represents a convenient alternative to the conventional transpopliteal approach.
Andrej Schmidt; Yvonne Bausback; Michael Piorkowski; Martin Werner; Sven Bräunlich; Matthias Ulrich; Ramon Varcoe; Josef Friedenberger; Johannes Schuster; Spiridon Botsios; Dierk Scheinert
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  19     ISSN:  1545-1550     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-08     Completed Date:  2012-06-04     Revised Date:  2013-07-23    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  23-9     Citation Subset:  IM    
Center for Vascular Medicine, Angiology, and Vascular Surgery, Park Hospital Leipzig, Germany.
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MeSH Terms
Aged, 80 and over
Angioplasty* / adverse effects
Angioplasty, Balloon* / adverse effects,  instrumentation
Arterial Occlusive Diseases / radiography,  therapy*
Catheterization, Peripheral* / adverse effects
Chronic Disease
Constriction, Pathologic
Femoral Artery* / radiography
Middle Aged
New South Wales
Patient Positioning
Retrospective Studies
Supine Position
Treatment Failure
Comment In:
J Endovasc Ther. 2013 Jun;20(3):440-1   [PMID:  23731322 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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