Retrograde popliteal access in the supine patient for recanalization of the superficial femoral artery: initial results.

PURPOSE

To report an initial experience of superficial femoral artery (SFA) recanalization performed with a dual femoral-popliteal approach in the supine patient.

METHODS

From May 2008 to April 2010, 26 patients (16 men; mean age 68 ± 6.3 years) with intermittent claudication and chronic SFA occlusion (mean length 97.4 ± 3.8 mm, range 35-220) underwent percutaneous recanalization from a retrograde popliteal access. The common femoral artery was punctured with an antegrade (n = 9) or retrograde contralateral (n = 17) approach, then with the patient still supine and the knee gently flexed and medially rotated, the popliteal artery was punctured using an 18-G needle under ultrasound (10, 38.4%) or fluoroscopic (16, 61.5%) guidance with a roadmap technique. Once the SFA was recanalized, the procedure was completed with angioplasty and stenting from the femoral approach. At the end of the procedure, hemostasis at the popliteal access was obtained with manual compression (5-10 minutes).

RESULTS

Technical success (puncture of the popliteal artery and SFA recanalization) was achieved in all cases. In the majority of patients (24, 91.6%), endoluminal recanalization was possible from the popliteal access; SFA recanalization in the other 2 cases was obtained through the subintimal space. Two small hematomas were found in the popliteal region, but no pseudoaneurysm or arteriovenous fistulas were seen on duplex examinations during a mean 12.5-month follow-up (range 6-28). Twenty (76.9%) SFAs were patent; in-stent restenosis occurred in the remaining 6 (23%). Primary patency was 80.7% at 6 months and 76.9% at 1 year. No stent fracture was observed.

CONCLUSION

The retrograde popliteal approach with the patient in the supine position can be considered a "first choice" method for safe and effective SFA recanalization, especially in occlusions located at the distal and mid portion SFA.