Retrograde 3-French popliteal approach in the supine position after failed antegrade angioplasty for chronic superficial femoral artery occlusion.
OBJECTIVE
To report use of a retrograde 3-F popliteal approach performed in a supine patient by lifting the heel after failed antegrade angioplasty for chronic total occlusion (CTO) in the superficial femoral artery (SFA).


METHODS
During subintimal angioplasty for a calcified 10-cm CTO in the distal left SFA of 65-year-old man with digital tissue loss, inability to re-enter the true lumen prompted us to place a 3-F sheath in a retrograde popliteal approach by lifting the heel so the patient could remain supine. The occlusive lesion was crossed retrogradely using a 0.014-inch floppy guidewire and serially dilated with a 4.0x40-mm monorail balloon through the 3-F popliteal sheath. Subsequent procedures (stenting and postdilation) were performed in an antegrade manner facilitated by a through-and-through wire. After the successful procedure, the 3-F sheath was removed in the catheterization laboratory, and a hemostasis device was left in place for 30 minutes, achieving hemostasis without any complication. During the 9-month follow-up, the patient remained asymptomatic and without evidence of restenosis.


CONCLUSIONS
A retrograde 3-F popliteal approach without the need for patient position change could be a convenient option for failed antegrade angioplasty of chronic SFA occlusions.
Kawarada
Osami
O
Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan. kawarada@stanford.edu
Yokoi
Yoshiaki
Y
D000368:Aged; D017130:Angioplasty / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005263:Femoral Artery; D006801:Humans; D008297:Male; D011150:Popliteal Artery; D015607:Stents; D016683:Supine Position