3:45 PM Abstract No. 313 Temporary retrograde superficial femoral artery puncture for challenging and otherwise uncrossable complete total occlusion in superficial femoral artery

Abstract

To evaluate safety and effectiveness of an innovative technique of using the back of the wire to support crossing catheter treating below-the-knee total occlusion. Five patients underwent conventional antegrade crossing techniques for proximal to mid SFA CTO. All had distal SFA reconstitution and all had failed the conventional techniques. Patients were decided to convert to retrograde ipsilateral distal SFA access under US guidance using a stiff micropuncture set. A .014, 300-cm wire was then pushed through the recalcitrant occlusive segment to the patent CFA with the support of 3F inner dilator of the stiff micropuncture set. The wire is then captured using a goose neck snare from the contralateral existing SFA access, forming a through-and-through access. The existing contralateral sheath is then advanced over the through-and-through wire crossing the CTO, staying true lumen. The temporary retrograde access is then abandoned. This is then followed by atherectomy and prolonged angioplasty. Five patients had an average age of 67 (range, 58-93), average BMI of 32, 1 smoker, 3 with left leg lesions, 5 are diabetic. Each patient underwent conventional contralateral access antegrade crossing techniques such as weighted tip wire (Abbott) and crossing catheter (Terumo and Philips) combination (in all 5 patients), crossing/atherectomy devices (in 3 patients) (Ra Medical Systems and Philips). All 5 patients were technically successful with complete SFA patency at the end of the procedure. 4 of the 5 patients were stented (Abbott Medical) due to ineffective angioplasty alone, and had 6 months patency based on US, 1 had reocclusion. 0 patients had postprocedural bleeding or hematoma at either ipsilateral SFA access or contralateral CFA access sites. Retrograde ipsilateral percutaneous access is safe and effective to assist intraluminal crossing of an otherwise untreatable complete total occlusion.