Bilateral transpopliteal approach for treatment of complex SFA and iliac occlusions

Abstract

We present a successful case of percutaneous intentional extraluminal recanalization (PIER) of bilateral long superficial femoral artery (SFA) occlusions and a long iliac artery occlusion through ultrasound-guided retrograde popliteal artery punctures. To our knowledge, PIER of SFA occlusions via popliteal approach has been reported in only three cases, and subintimal recanalization of combined SFA and iliac occlusions has not been reported.

Strategies for Successful Percutaneous Revascularization of Chronic Total Occlusion of the Femoropopliteal Arteries When the Antegrade Passage of a Guide Wire Fails

“…In fact, in the present study, one case occurred in which the creation of a new reentry site proximal to the remote reentry site created by the traditional subintimal technique allowed the stent to be placed, overcoming the suboptimal subintimal balloon angioplasty. Some surgeons report using retrograde popliteal access (15) for subintimal recanalization or a "kissing catheter" or "wire pull-through" technique (16, 17), which requires two access sites (femoral and popliteal). After femoral access and catheter or guide wire advancement through the subintimal plane around the occlusion, the patient is placed in a prone position, and the popliteal artery is accessed.…”

Novel devices and specialized techniques in recanalization of peripheral artery chronic total occlusions (CTOs) — A literature review

“…Yilmaz et al [36] recommended routine use of ultrasound guidance during the puncture procedure which can help demonstrate the orientation of the popliteal artery and vein in order to exclude the risk of arteriovenous fistula formation and to exclude the presence of a popliteal artery aneurysm where puncture would be hazardous. Alternatively, the retrograde puncture can be performed under fluoroscopic guidance: following dye injection from the femoral access the vessel at the intended puncture site will be filled with contrast medium via collaterals.…”

“…No puncture site hematoma or arteriovenous fistula was encountered. In 2005 Yilmaz et al [36] published a retrospective review of 174 consecutive patients with 247 iliofemoral lesions who underwent retrograde popliteal artery catheterization using the ultrasound guidance. Their technical success was 100% and no complications occurred.…”

Novel use of ultrasound guidance for recanalization of iliac, femoral, and popliteal arteries

“…Several reports have suggested that the initial success rate is high, but long-term patency is poor in the endovascular therapy of the femoropopliteal artery occlusive disease [8][9][10]. In order to recanalize the CTO lesions in the femoropopliteal artery, several techniques such as the subintimal technique [11], the duplexguided technique [12], and the bidirectional subintimal angioplasty via a popliteal artery approach [13,14] have been developed. In the subintimal technique, a stiff 0.035-in.…”