3:54 PMAbstract No. 154 - Retrograde popliteal arterial access for recanalization of lower extremity chronic total occlusion (CTO)

Abstract

Traditionally, lower extremity arterial lesions are addressed through a retrograde approach via the contralateral common femoral artery, otherwise known as the “up-and-over” technique. However, this approach may not be feasible in patients with difficult contralateral access with failure rates up to 20%. Patients with occluded contralateral arteries or aorto-iliac grafts may also be precluded from this approach. For these cases, retrograde popliteal access provides an alternative to traditional approaches. The goal of this study is to demonstrate the efficacy and safety of retrograde popliteal access as a suitable alternative to traditional access techniques for addressing lower extremity chronic total occlusion (CTO). 13 cases of patients with superficial femoral artery (SFA) occlusions underwent percutaneous recanalization via retrograde popliteal artery access. Patients were primarily selected for previously failed or unfeasible contralateral retrograde femoral approaches. Ultrasound-guided popliteal access was obtained in prone position, followed by recanalization. Hemostasis was achieved through ultrasound-guided compression. Follow-up ultrasonography determined post-procedural vessel patency. Popliteal arterial access was successfully obtained in all cases. Successful recanalization was achieved in 84.6% (11/13) cases via popliteal intervention. Failures were due to inability to fully traverse SFA lesions. Complications included two instances of distal embolization; one resolved without intervention, while the other resolved following thrombolysis. Post-procedural ultrasound follow-up demonstrated one occlusion (10 months) and one stenosis (11 days) but otherwise patent vessels were seen. No complications associated with access site bleeding. Our study demonstrates that ultrasound-guided popliteal arterial access can be safely and effectively used to recanalize the SFA. Retrograde popliteal access should be a tool for interventionalists in the management of peripheral vascular disease.