Korean Circ J.  2008 Oct;38(10):557-560. 10.4070/kcj.2008.38.10.557.

Successful Recanalization of a Long Superficial Femoral Artery Occlusion by Retrograde Subintimal Angioplasty After a Failed Antegrade Subintimal Approach

• Choi JH
• Ryu YS
• Suh J
• Seo HS
• Cho YH
• Lee NH

• KMID: 2225721
• DOI: http://doi.org/10.4070/kcj.2008.38.10.557

Abstract

The primary success rate of intraluminal angioplasty for long superficial femoral artery (SFA) occlusions is low due to the long occlusion length and the hard component of the occlusion. To overcome this problem, subintimal angioplasty has been previously proposed and this technique is now considered as an effective method for the treatment of SFA occlusions. Subsequently, various devices and strategies have been developed to increase the success rate of subintimal angioplasty for SFA occlusions. Here, we present a case in which a long chronic total occlusion of SFA was successfully recanalized by the retrograde subintimal angioplasty through the popliteal artery after the failed antegrade subintimal approach.

Keyword

Percutaneous transluminal angioplasty; Femoral artery; Popliteal artery

MeSH Terms

Angioplasty
Femoral Artery
Popliteal Artery

Figure

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  Fig. 1 Pre-interventional computed tomography (A and B) and conventional angiography (C and D) showing the total occlusion of the right SFA from the ostium (white arrow) to the distal level (black arrow) with the length of 230 mm. SFA: superficial femoral artery.

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  Fig. 2 Serial findings of failed antegrade subintimal angioplasty. The wire with the support of a 5 Fr Glide catheter was moved through the subintimal space down to the distal occlusion site (A). Re-entrance of the wire into the true lumen distal to the occlusion failed (B).

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  Fig. 3 Retrograde subintimal angioplasty through a popliteal artery. Angiography of the popliteal artery (A). The 0.035 inch Radifocus guide wire re-entered the proximal true lumen (white arrow) (B). The passed wire was introduced into the Balkin sheath and guided outside the body (C). Final image after the placement of three Smart stents (D).

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