The Popliteal Approach: A New Approach to Percutaneous Laser-Assisted Angioplasty

Abstract

"Hot-tip" laser angioplasty has been proven safe and effective in treating periperal vascular disease. There is, however, a group of patients with lesions or occlusions at the origin of the superficial femoral artery (SFA) that are difficult to approach from a standard antegrade femoral approach. The authors have developed a new retrograde popliteal approach that allows laser angioplasty to be performed percutaneously in these patients; 51 consecutive cases have been treated and followed up for more than one year. There were 40 cases with lesions greater than 9 cm long (Group A), while 11 cases had lesions less than 9 cm long (Group B). The mean lesion length was 15 cm. The initial success rate was 32 of 51 cases (63%): 24 of 40 cases (60%) in Group A and 8 of 11 cases (73%) in Group B proved successful. A three-month follow-up showed that clinical patency was 100% in initially successful cases (32 of 32 cases overall, 24 of 24 cases in Group A, and 8 of 8 cases in Group B). A twelve-month follow-up showed clinical patency in 20 of 32 initally successful cases (63%); 14 of 24 cases (58%) in Group A and 6 of 8 cases in Group B (75%) remained patent at twelve months. The authors conclude that the popliteal approach to laser-assisted angioplasty is a safe and effective method of treating lesions at the origin of the SFA that could not be treated with any other percutaneous approach. One-year follow-up results in these patients are encouraging.