Retrograde 3-French Popliteal Approach in the Supine Position After Failed Antegrade Angioplasty for Chronic Superficial Femoral Artery Occlusion

Abstract

To report use of a retrograde 3-F popliteal approach performed in a supine patient by lifting the heel after failed antegrade angioplasty for chronic total occlusion (CTO) in the superficial femoral artery (SFA). During subintimal angioplasty for a calcified 10-cm CTO in the distal left SFA of 65-year-old man with digital tissue loss, inability to re-enter the true lumen prompted us to place a 3-F sheath in a retrograde popliteal approach by lifting the heel so the patient could remain supine. The occlusive lesion was crossed retrogradely using a 0.014-inch floppy guidewire and serially dilated with a 4.0x40-mm monorail balloon through the 3-F popliteal sheath. Subsequent procedures (stenting and postdilation) were performed in an antegrade manner facilitated by a through-and-through wire. After the successful procedure, the 3-F sheath was removed in the catheterization laboratory, and a hemostasis device was left in place for 30 minutes, achieving hemostasis without any complication. During the 9-month follow-up, the patient remained asymptomatic and without evidence of restenosis. A retrograde 3-F popliteal approach without the need for patient position change could be a convenient option for failed antegrade angioplasty of chronic SFA occlusions.