Korean Circ J.  2014 May;44(3):184-188. 10.4070/kcj.2014.44.3.184.

Retrograde Distal Superficial Femoral Artery Approach in the Supine Position for Chronic Superficial Femoral Artery Occlusion

• Shin S
• Kim S
• Ko YG
• Hong MK
• Jang Y
• Choi D

• KMID: 2145480
• DOI: http://doi.org/10.4070/kcj.2014.44.3.184

Abstract

Subintimal angioplasty is an effective method for the treatment of long superficial femoral artery (SFA) occlusions. One of the major limiting factors for the success of this procedure is the failure to re-enter the true lumen. The recently introduced luminal re-entry devices provide a high technical success rate, but failures can occur. In such cases, a retrograde popliteal approach can serve as a potential backup option. However, the need to reposition the patient remains a drawback. Here, we report a case of an 81-year-old male with a long SFA occlusion treated using a retrograde distal SFA approach in the supine position after the initial failure of antegrade angioplasty.

Keyword

Peripheral arterial disease; Femoral artery; Angioplasty

MeSH Terms

Aged, 80 and over
Angioplasty
Femoral Artery*
Humans
Male
Peripheral Arterial Disease
Phenobarbital
Supine Position*
Phenobarbital

Figure

• 

  Fig. 1 A total occlusion of about 25 cm of the right superficial femoral artery with reconstitution of the distal superficial femoral artery (A and B) and failure to find the distal re-entry site with a hydrophilic wire (C) and re-entry catheter (D).

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  Fig. 2 The distal SFA is punctured at the proximal part of the adductor canal with a 21-gauge micropuncture needle under a roadmap fluoroscopic guidance, and an angiogram is performed through a 3 Fr dilator to confirm that the access to the SFA is achieved properly (A). Then, a 5 Fr sheath is inserted into the distal SFA (B).

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  Fig. 3 After dilation with a 6.0×40 mm balloon (A), angiogram shows diffuse dissection of the superficial femoral artery (B). Two self-expanding nitinol stents are placed in the superficial femoral artery (C), which yields a satisfactory final result (D).

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