Shennib Hani, Teribery Emily, Evans Amanda, Huerta Victor
Department of Surgery, College of Medicine, University of Arizona, Phoenix, AZ.
Department of Surgery, Midwestern University, Glendale, AZ.
J Vasc Surg. 2025 Jan;81(1):165-171. doi: 10.1016/j.jvs.2024.08.055. Epub 2024 Aug 30.
Popliteal access as an alternative to conventional femoral access has not been reported in the office-based catheter laboratory setting (OBL) and may be perceived to have higher risks. The purpose of this study was to evaluate the safety and efficacy of popliteal access for the endovascular treatment of iliofemoral arterial occlusive disease in an OBL setting.
From October 2018 to October 2023, a total of 1408 interventions for peripheral artery disease were performed in our OBL. A cohort of 27 popliteal access consecutive procedures for femoral and iliac artery occlusions were studied. All interventions were done using a micropuncture needle under ultrasound guidance. All patients were discharged 1 hour after completion of the procedure. Indications for popliteal access were presence of aortoiliac stent grafts, aortobifemoral or aortoiliac bypasses, difficult contralateral or antegrade femoral access, and flush superficial femoral artery occlusions. Procedures were determined to be successful upon complete resolution of the target lesions and safety was measured perioperatively and at 90 days. Patency was determined clinically, by arterial duplex examination, and by need for reintervention for ≤2 years.
We performed 27 popliteal access procedures in 25 patients (21 complete femoral artery occlusions, 6 severe stenosis). Iliac disease was present in nine. Indications for popliteal access were existing aortoiliac stent graft in 11, aortobifemiliac bypass in 4, noncrossable iliac occlusions in 3, failed antegrade femoral access in 4, flush superficial femoral artery occlusion in 3, and bilateral common femoral artery disease precluding access in 2. Trans-Atlantic Inter-Society Consensus classification preoperatively was B, 4; C, 4; and D, 19. Treatments included atherectomy/balloon angioplasty and stent in 12, balloon angioplasty and stenting in 4, atherectomy/balloon angioplasty in 5, and balloon angioplasty alone in 6. Successful opening of occlusions occurred in 25 of 27 patients (92.5%). No complications or major adverse cardiac events occurred, except one asymptomatic small popliteal arteriovenous fistula. Of the 25 successful procedures, the duplex patency at 3, 6, and 12 months was 19/20 (95%), 11/15 (69.3%), and 11/13 (61%). Rutherford Classification improved from a preoperative value of >4 in 24 of 27 (89%) to a postoperative value of <2 at 1 month in 23 of 23 (100%), at 3 months in 19 of 20 (95%), at 6 months in 11 of 15 (69.3%), and at 12 months in 11 of 13 (61%). Freedom from reintervention at 3 months occurred in 19 of 20 (95%), at 6 months in 13 of 15 (86%), and at 12 months in 12 of 13 (79%).
Popliteal artery access for complex iliofemoral disease is safe and effective and should be considered as a valid alternative option in the OBL setting.
在门诊导管实验室环境（OBL）中，腘动脉入路作为传统股动脉入路的替代方法尚未见报道，且可能被认为风险更高。本研究的目的是评估在OBL环境下，腘动脉入路用于髂股动脉闭塞性疾病血管内治疗的安全性和有效性。
2018年10月至2023年10月，我们的门诊导管实验室共进行了1408例外周动脉疾病干预手术。研究了一组连续27例采用腘动脉入路治疗股动脉和髂动脉闭塞的手术。所有干预均在超声引导下使用微穿刺针完成。所有患者在手术完成后1小时出院。腘动脉入路的适应证包括存在主动脉髂动脉支架移植物、主动脉双股动脉或主动脉髂动脉旁路移植、对侧或顺行股动脉入路困难以及股浅动脉近心端闭塞。当目标病变完全消退时，手术判定为成功，并在围手术期和90天时评估安全性。通过临床检查、动脉双功超声检查以及2年内是否需要再次干预来确定通畅情况。
我们对25例患者进行了27例腘动脉入路手术（21例股动脉完全闭塞，6例严重狭窄）。9例存在髂动脉疾病。腘动脉入路的适应证为：11例存在主动脉髂动脉支架移植物，4例存在主动脉双股动脉旁路移植，3例髂动脉闭塞无法通过，4例顺行股动脉入路失败，3例股浅动脉近心端闭塞，2例双侧股总动脉疾病无法进行入路。术前跨大西洋跨学会共识分类为B级4例、C级4例、D级19例。治疗方法包括12例旋切术/球囊血管成形术和支架置入、4例球囊血管成形术和支架置入、5例旋切术/球囊血管成形术、6例单纯球囊血管成形术。27例患者中有25例（92.5%）成功开通闭塞。除1例无症状小腘动脉动静脉瘘外，未发生并发症或重大不良心脏事件。在25例成功手术中，3个月、6个月和12个月时双功超声检查显示的通畅率分别为19/20（95%）、11/15（69.3%）和11/13（61%）。卢瑟福分类从术前27例中的24例（89%）>4级改善为术后1个月时23例中的23例（100%）<2级、3个月时20例中的19例（95%）<2级、6个月时15例中的11例（69.3%）<2级、12个月时13例中的11例（61%）<2级。3个月时无需再次干预的比例为20例中的19例（95%），6个月时为15例中的13例（86%），12个月时为13例中的12例（79%）。
腘动脉入路用于复杂髂股动脉疾病是安全有效的，在OBL环境中应被视为一种有效的替代选择。
