Lüdtke Christopher W, Scheer Fabian, Kamusella Peter, Wissgott Christian, Andresen Reimer
Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany.
Clin Med Insights Cardiol. 2015 Feb 24;8(Suppl 2):23-8. doi: 10.4137/CMC.S15230. eCollection 2014.
Recanalization of chronic total occlusions (CTOs) of the femoropopliteal arteries depends on a successful lesion crossing with the guide wire. The aim of this retrospective study was to evaluate the safety, feasibility, and the primary results of retrograde recanalization of CTOs with balloon-assisted excimer-laser atherectomy (ELA) via a transpopliteal approach after failed antegrade attempts.
A total number of 15 patients (10 male, 5 female) with a mean age of 68.5 years (range: 43-91 years) treated with retrograde transpopliteal ELA in the years 2009-2012 were included retrospectively. After unsuccessful antegrade recanalization attempts with conventional guide wires and catheters, patients were treated with a retrograde recanalization attempt via a transpopliteal access using an excimer laser, followed by pressure-only balloon angioplasty (POBA). The mean length of the CTOs in the femoropopliteal arteries was 17.8 ± 5.4 cm (range: 9-29 cm).
Technically successful recanalization was achieved in 14 of 15 patients. Provisional stenting was done in two cases. There were no major adverse events regarding the laser atherectomy or popliteal access site. One acute reocclusion was observed in the first 48 hours after intervention. The ankle-brachial Index increased from preinterventional 0.45 ± 0.07 to 0.77 ± 0.29 (P < 0.05) in the follow-up period (1.5 months), resulting in a primary patency of 80%.
The retrograde ELA for recanalization of chronic femoropopliteal occlusions via a popliteal access turned out to be a safe and effective procedure with promising primary results. Thus it may be an endovascular treatment option for long chronic occlusions after failed antegrade recanalization or in patients who are not suitable for surgery.
股腘动脉慢性完全闭塞（CTO）的再通取决于导丝成功穿过病变。本回顾性研究的目的是评估在顺行尝试失败后，经腘动脉途径采用球囊辅助准分子激光斑块切除术（ELA）逆行再通CTO的安全性、可行性和初步结果。
回顾性纳入2009年至2012年期间接受逆行腘动脉ELA治疗的15例患者（男10例，女5例），平均年龄68.5岁（范围：43 - 91岁）。在使用传统导丝和导管进行顺行再通尝试失败后，患者通过腘动脉入路采用准分子激光进行逆行再通尝试，随后进行单纯球囊血管成形术（POBA）。股腘动脉CTO的平均长度为17.8±5.4 cm（范围：9 - 29 cm）。
15例患者中有14例在技术上成功实现再通。2例患者进行了临时支架置入。在激光斑块切除术或腘动脉入路部位未发生重大不良事件。干预后48小时内观察到1例急性再闭塞。随访期（1.5个月）内，踝肱指数从干预前的0.45±0.07增加至0.77±0.29（P<0.05），初始通畅率为80%。
经腘动脉入路采用逆行ELA再通慢性股腘动脉闭塞是一种安全有效的方法，初步结果良好。因此，对于顺行再通失败的长段慢性闭塞或不适合手术的患者，它可能是一种血管内治疗选择。
