J Cardiovasc Interv.  2025 Jul;4(3):201-211. 10.54912/jci.2024.0037.

Chronic Total Occlusion of the Femoropopliteal Artery: How to Recanalize

• Kim SH

• KMID: 2570251
• DOI: http://doi.org/10.54912/jci.2024.0037

Abstract

In patients with peripheral arterial disease who experience claudication, chronic total occlusion (CTO) of the femoropopliteal (FP) artery is often encountered and remains challenging for interventionists. Advances in techniques and devices over recent decades have expanded the scope of endovascular recanalization. The prognosis after recanalization of CTO of the FP artery has also improved with approaches such as drug-coated balloons, drug-eluting stents, atherectomy devices, and intravascular ultrasound; however, these treatments cannot be applied if guidewire (GW) crossing—the most basic form of recanalization—is unsuccessful. This review focuses on common endovascular techniques that employ both antegrade and retrograde approaches in CTO of the FP artery. Additionally, it covers GW selection and re-entry devices.

Keyword

Femoral artery; Popliteal artery; Endovascular procedures; Arterial occlusive diseases; Punctures