title: Combined antegrade femoral artery and retrograde popliteal artery recanalization for chronic occlusions of the superficial femoral artery.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of a dual femoral-popliteal approach in the supine position after failed antegrade recanalization attempts in chronic total occlusion (CTO) of the superficial femoral artery (SFA).
  
  
  METHODS
  From May 2011 to October 2012, 21 patients underwent dual femoral-popliteal recanalization for CTO of the SFA, with a mean lesion length of 87.4 mm ± 5.8. When contralateral antegrade recanalization of SFA occlusions via the common femoral artery could not be achieved, the occlusions were intrainterventionally accessed by retrograde approach via the popliteal artery, which was punctured anteriorly with gently flexed knee and crus extorsion. When the SFA had been recanalized, further angioplasty and stent placement procedures were completed via the femoral artery.
  
  
  RESULTS
  A technical success rate of 100% (entailing puncture of the popliteal artery and SFA recanalization) was achieved, and no hemorrhage, hematoma, pseudoaneurysm, arteriovenous fistula, or other complications developed. During a mean follow-up of 9.8 months ± 1.5, claudication severity, rest pain, and toe ulcers improved significantly. The pulse of the distal arteries, as well as the filling of the veins, could be distinctly felt. Ankle-brachial index changed from 0.48 ± 0.17 to 0.84 ± 0.11 at 1 year after intervention (P < .001), and patency rates at 1, 6, and 12 months after interventions were 100%, 80%, and 42%, respectively.
  
  
  CONCLUSIONS
  A dual femoral-popliteal approach in the supine position is an alternative backup option after failed attempts at the antegrade approach for patients with proximal barriers in CTO or lesions with major extending collateral vessels.
authors.affiliation: Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Weihao
authors.initials: W
authors.lastname: Shi
authors.affiliation: Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China. Electronic address: yaoyeBM@163.com.
authors.forename: Ye
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.affiliation: Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Song
authors.initials: S
authors.lastname: Wang
authors.affiliation: Surgery of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Huafa
authors.initials: H
authors.lastname: Que
authors.affiliation: Surgery of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Huanyu
authors.initials: H
authors.lastname: Xiang
authors.affiliation: Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Qiong
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Qiufeng
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Surgery of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Surgery of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Jienan
authors.initials: J
authors.lastname: Xu
authors.affiliation: Surgery of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Liu
authors.affiliation: Surgery of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Shen
authors.affiliation: Surgery of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Xing
authors.affiliation: Surgery of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Surgery of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Shan
authors.affiliation: General Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Rd., Shanghai 200032, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D055109:Ankle Brachial Index; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002908:Chronic Disease; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011677:Punctures; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D016683:Supine Position; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency