Transpopliteal stenting of femoral occlusions in patients with critical limb ischemia using a 4-French system.
OBJECTIVE
In many patients with critical limb ischemia (CLI), transfemoral endovascular recanalization is the preferred treatment. Transpopliteal treatment may be used in patients with inaccessible groins. This retrospective study regards transpopliteal stenting of superficial femoral artery (SFA) occlusions using a 4F system.


METHODS
Eleven patients (4 male and 7 female [mean age 77 years]) underwent 12 attempts of transpopliteal recanalization of long SFA occlusions (Trans-Atlantic InterSociety Consensus B through D). All patients had CLI (Rutherford 4 to 6) and were nonoperable due to poor general condition. Indications for transpopliteal access were proximal/flush SFA occlusions (n = 5), failure of antegrade recanalization (n = 4), infected femoral-femoral crossover bypass (n = 2), and occlusion of both the native SFA and the femoral-popliteal bypass (n = 1). The popliteal artery was punctured under ultrasound guidance. Occlusions were recanalized subintimally, and 4F compatible stents were implanted.


RESULTS
Technical success rate (<30 % residual stenosis) was achieved in 83 % of cases. In two patients, stent dislocation occurred while the sheath was removed. One arteriovenous fistula was successfully treated with additional stenting. During 6-month follow-up, there were no major amputations, and three patients died from nonrelated causes. Fifty percent of patients alive after 6 months improved to Rutherford score ≤3. The duplex restenosis (>50 %) rate at 6 months was 50 %.


CONCLUSIONS
Transpopliteal primary stenting of complex SFA lesions in CLI for a temporary bypass is now technically feasible using a 4F system. Technical results are promising. Clinical results after 6 months are acceptable when taking into consideration that this approach may be the last option for limb salvage.
Department of Radiology, HagaZiekenhuis, PO box 40551, 2504 LN, The Hague, The Netherlands, m.spreen@hagaziekenhuis.nl.
Marlon
M
Spreen
Ted
T
Vink
Bob
B
Knippenberg
Jim
J
Reekers
Lukas
L
van Dijk
Jan
J
Wever
Randolph
R
van Eps
Hans
H
van Overhagen
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D011150:Popliteal Artery; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D062666:Vascular Access Devices