Tan Michinao, Urasawa Kazushi, Koshida Ryoji, Haraguchi Takuya, Kitani Shunsuke, Igarashi Yasumi, Sato Katsuhiko
1 Cardiovascular Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan.
J Endovasc Ther. 2017 Aug;24(4):525-530. doi: 10.1177/1526602817713307. Epub 2017 Jun 7.
To describe the feasibility and safety of an anterolateral popliteal puncture technique as a retrograde access to chronic total occlusions (CTOs) in the femoropopliteal segment.
Twenty consecutive patients (mean age 75.1±10.9 years; 13 women) with symptomatic femoropopliteal occlusive disease underwent endovascular therapy via a retrograde access using the anterolateral popliteal puncture technique. With the patient supine, the P3 segment of the popliteal artery was accessed with a sheathless technique intended to provide minimally invasive access. Subsequent to a wire rendezvous technique in the CTO, the antegrade guidewire was advanced to the below-the-knee artery. Hemostasis across the P3 segment was secured with balloon inflation alone or combined with thrombin-blood patch (TBP) injection.
Both the anterolateral popliteal puncture technique and subsequent revascularization were successful in all patients. Mean hemostasis time for balloon inflation only was 7.73±4.03 vs 4.78±0.78 minutes for balloon inflation with TBP injection. There were no in-hospital deaths or complications, including pseudoaneurysms, arteriovenous fistulas, hematomas, embolic complications, or nerve damage.
The anterolateral popliteal puncture technique is useful as an alternative retrograde access vs a conventional transpopliteal approach for CTOs in the femoropopliteal segment if antegrade recanalization has failed. This technique may become one option for retrograde access in patients with severe below-the-knee lesions or with CTOs that extend to the P2 segment of the popliteal artery. Furthermore, this technique has the added benefit of allowing patients to remain in the supine position throughout treatment.
描述一种腘前外侧穿刺技术作为逆行进入股腘段慢性完全闭塞（CTO）病变的可行性和安全性。
连续20例有症状的股腘闭塞性疾病患者（平均年龄75.1±10.9岁；13例女性）通过使用腘前外侧穿刺技术的逆行入路接受血管内治疗。患者仰卧位，采用无鞘技术进入腘动脉P3段，旨在提供微创入路。在CTO病变中采用导丝会师技术后，将顺行导丝推进至膝下动脉。仅通过球囊扩张或联合凝血酶-血补丁（TBP）注射来确保P3段的止血。
所有患者的腘前外侧穿刺技术及随后的血管重建均成功。仅球囊扩张的平均止血时间为7.73±4.03分钟，而联合TBP注射的球囊扩张平均止血时间为4.78±0.78分钟。无院内死亡或并发症，包括假性动脉瘤、动静脉瘘、血肿、栓塞并发症或神经损伤。
如果顺行再通失败，对于股腘段CTO病变，腘前外侧穿刺技术作为一种替代逆行入路，相对于传统的经腘入路是有用的。对于严重膝下病变或CTO病变延伸至腘动脉P2段的患者，该技术可能成为逆行入路的一种选择。此外，该技术的额外优势是在整个治疗过程中患者可保持仰卧位。
