Retrograde recanalization technique for use after failed antegrade angioplasty in chronic femoral artery occlusions.
OBJECTIVE
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.


CONCLUSIONS
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.
Center for Vascular Medicine, Angiology, and Vascular Surgery, Park Hospital Leipzig, Germany. Andrej.schmidt@gmx.de
Andrej
A
Schmidt
Yvonne
Y
Bausback
Michael
M
Piorkowski
Martin
M
Werner
Sven
S
Bräunlich
Matthias
M
Ulrich
Ramon
R
Varcoe
Josef
J
Friedenberger
Johannes
J
Schuster
Spiridon
S
Botsios
Dierk
D
Scheinert
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002908:Chronic Disease; D003251:Constriction, Pathologic; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D056888:Patient Positioning; D011677:Punctures; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D016683:Supine Position; D017211:Treatment Failure