Superficial Femoral Artery Occlusion Research Articles

Acute lower limb ischemia caused by repeat deployment of vascular closure device.

Vascular closure devices are used to facilitate faster hemostasis and earlier ambulation, improve patient comfort, and reduce length of hospital stay after percutaneous endovascular procedures. However, their use may rarely be associated with limb ischemia due to endothelial damage and arterial thrombosis. This report illustrates the case of a patient who experienced acute lower limb ischemia due to superficial femoral artery occlusion caused by repeat closure with Angio-Seal vascular closure device within 30 days in a small-caliber superficial femoral artery. The patient was surgically treated by vascular repair with a synthetic graft, and remains symptom-free in 3-year follow-up. Repeat deployment of vascular closure devices in the same access site within a period of 30 days may cause acute limb ischemia due to arterial thrombosis, especially in patients with small-caliber arteries, even in the absence of evident risk factors.

The Untold Story: Early and Mid-Term Results of Subintimal Angioplasty in Superficial Femoral Artery Versus Popliteal Artery Chronic Total Occlusion.

This study aims to compare the immediate and mid-term outcomes of subintimal angioplasty (SIA) of chronic total occlusions (CTOs) of superficial femoral artery (SFA) versus popliteal artery (PA) and to identify possible predictors of loss of limb-based patency (LBP). This is a retrospective analysis of chronic lower-limb ischemia (CLI) patients (Rutherford classes 3-6) presenting with CTO of SFA or PA treated by SIA and selective stenting in the period 2018 to 2021. Immediate outcomes were compared between the SFA and PA groups, including technical success, perioperative complications, and 30-day major amputation and mortality rates. Mid-term outcomes for technically successful procedures included limb-based patency (LBP), wound healing rate, amputation-free survival (AFS), and major adverse limb events (MALEs). A total of 450 CLI patients underwent SIA of CTO at the SFA (n=260, 57.8%) and the PA (n=190, 42.2%). The indication for revascularization was chronic limb-threatening ischemia in 80.8% of SFA group and 84.2% of PA group. Technical success rate was higher in the PA group compared to the SFA group (96.3% vs 91.2%; p=0.03). The 30-day amputation rates were comparable between the SFA and PA groups (7.7% vs 6.8%, p=0.7, respectively). No perioperative mortality or systemic major complications occurred in the present study. Kaplan-Meier estimate of the 1-year rates were significantly better for SFA group regarding LBP (82% for SFA group vs 43% for PA group, p=0.006), AFS (88% vs 64%, p=0.02), and wound healing (79% vs 58%, p=0.027), respectively. The number of runoff vessels was the only factor associated with loss of LBP (hazard ratio [HR], 0.055; 95% confidence interval [CI]: 0.001-3.020, p=0.039). Subintimal angioplasty is an effective and safe endovascular treatment option of CTO at SFA and PA with satisfactory immediate outcomes. The mid-term outcomes, however, are better for SFA lesions in terms of improved LBP, AFS, and wound healing rates. Subintimal angioplasty is a valuable tool in the armamentarium of endovascular surgeons, as re-entry devices aren't always widely accessible. This study aims to assess the technical outcomes of peripheral vascular interventions for infrainguinal chronic total occlusions and identify possible predictors for successful subintimal angioplasty .Subintimal angioplasty is an effective treatment option for infrainguinal CTO with difference in result of immediate outcomes in popliteal lesions and SFA lesions.

Popliteal access for iliofemoral occlusive disease in the office-based catheter laboratory

ObjectivePopliteal 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. MethodsFrom 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. ResultsWe 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%). ConclusionsPopliteal artery access for complex iliofemoral disease is safe and effective and should be considered as a valid alternative option in the OBL setting.

Remote Endarterectomy Facilitated With a Flexible Ureteroscope System for Treating Superficial Femoral Artery Occlusion.

Remote Endarterectomy Facilitated With a Flexible Ureteroscope System for Treating Superficial Femoral Artery Occlusion.

A latent bleeding complication in ipsilateral common femoral puncture involving delayed diagnosis: a case report

BackgroundThe trans femoral ipsilateral approach is often adopted for endovascular treatment (EVT) for better steerability of guidewires or better device deliverability. However, contrary to the trans femoral contralateral approach, ipsilateral antegrade puncture sometimes causes peculiar bleeding complications.Case presentationA 76-year-old female underwent EVT for chronic occlusion of the left superficial femoral artery (SFA) via the ipsilateral antegrade approach. After guidewire passage, we inflated the drug-coated balloons, but angiography showed blood flow stasis at the mid segment of the SFA. We also ensured prolonged balloon inflation, which resulted in favorable blood flow. While trying to ensure hemostasis, the blood pressure remained decreased, but neither bleeding nor superficial hematoma were observed at the puncture site. After hemostasis was achieved, we removed the surgical drape and noticed a swelling in the mid-portion of the thigh, distant from the puncture point. We then approached the left common femoral artery (CFA) contralaterally. Angiography showed continuous bleeding from a little bit distally to the sheath insertion point that was spreading through an intramuscular space. We stopped the bleeding with balloon tamponade inside the CFA. Angiography after hemostasis demonstrated blood flow stasis at the mid-segment of the SFA, similarly as that seen before. We confirmed compression of the SFA by a large hematoma using both intra- and extra- vascular ultrasound. Therefore, we deployed a self-expandable stent at the compressed SFA position. Finally, we achieved favorable blood flow on angiography.ConclusionWe encountered a case that latent bleeding unrecognized in the surgical field persisted while prolonged inflation of DCB was conducted at just proximal SFA. We could have avoided bailout stenting by noticing the bleeding incident in a timely manner. Prediction and prevention are essential for all kinds of procedural complications in EVT.

Recanalization of superficial femoral artery chronic total occlusion through retrograde popliteal approach recanalization of superficial femoral artery chronic total occlusion

PurposeThis retrospective study aims to evaluate the safety, practicality, and efficacy of the independent retrograde popliteal approach for recanalization superficial femoral artery (SFA) occlusions when the bilateral common femoral artery approach is unavailable, such as after endovascular aneurysm repair or common iliac artery stenting. MethodsThis treatment was considered for patients with contralateral iliac artery occlusion, severe iliac tortuosity, or those who had previously undergone endovascular aneurysm repair or common iliac stenting. Patients with SFA lesions extending into the P1–P2 segment of the popliteal artery or with calcification in the P3 segment were excluded. Angioplasty and stenting were conducted via the popliteal artery approach, with hemostasis at the puncture site achieved using an EXOSEAL vascular closure device. Patients were routinely followed up at 3, 6, and 12 months, and annually thereafter. ResultsForty-eight consecutive patients with SFA occlusion who underwent endovascular treatment via the retrograde popliteal artery approach were included in this study. Retrograde puncture of the popliteal artery was successful in all cases. Six-French sheaths were utilized in all procedures. The EXOSEAL vascular closure device was successfully applied in all 48 cases. No instances of pseudoaneurysms, arteriovenous fistulas, major bleeding, or embolic complications were observed. The technical success rate for SFA recanalization was 100 %. All patients experienced clinical improvement. The ankle-brachial index significantly increased from an initial 0.33 ± 0.11 at admission to 0.81 ± 0.19 at discharge (P < 0.001). The mean follow-up period was 25.1 ± 11.7 months. Kaplan-Meier analysis revealed primary patency rates of 82.5 % at 12 months and 71.8 % at 24 months. No patients required major amputation during the follow-up period. ConclusionThe endovascular treatment of SFA occlusions via the independent retrograde popliteal approach is a viable alternative, demonstrating a low incidence of puncture-related complications and a high success rate of recanalization.

Endovascular Transvenous versus Open Femoropopliteal Bypass.

Background and Objectives: Lower extremity arterial disease is one of the most prevalent manifestations of atherosclerosis. The results from numerous studies regarding the best revascularization method of an occluded superficial femoral artery have been conflicting. The aim of this study was to compare the patency of transvenous endovascular with open femoropopliteal bypass, both with vein and prosthetic grafts. To our knowledge, a direct patency comparison between transvenous endovascular and open femoropopliteal bypass has not been published. This could help elucidate which method is preferable and in which cases. Materials and Methods: Patients with complex TASC-C and D SFA lesions were offered endovascular transvenous or open bypass. A total of 384 consecutive patients with PAD requiring surgical treatment were evaluated for inclusion in this study. Three-year follow-up data were collected for 52 endovascular procedures, 80 prosthetic grafts, and 44 venous bypass surgeries. Bypass patency was investigated by Duplex US every 6 months. Kaplan-Meier plots were used to analyze primary, primary-assisted, and secondary patency for endovascular transvenous, autovenous, and prosthetic bypasses. Results: Primary, primary-assisted, and secondary patency in venous group at 3 years was 70.5%, 77.3%, and 77.3%, respectively. In the endovascular transvenous group, primary, primary-assisted, and secondary patency at 3 years was 46.2%, 69.2%, and 76.9%, respectively. The lowest patency rates at 3 years were noted in the prosthetic graft group with 22.5% primary, 26.6% primary-assisted, and 28.2% secondary patency. Conclusions: The saphenous vein is the best graft to perform in above-the-knee femoropopliteal bypass. Transvenous endovascular bypass is a viable option with comparable primary-assisted and secondary patency. Primary patency is substantially lower for endovascular transvenous compared to venous bypass. Patients treated with endovascular transvenous bypass will require a significant number of secondary procedures to provide optimal patency. Prosthetic grafts should only be used if no other option for bypass is available.

Successful Bail-Out With Vasodilator Injection Using Dilated Over-the-Wire Balloon for Slow-Flow Phenomenon After Drug-Coated Balloon for Superficial Femoral Artery Occlusion.

Successful Bail-Out With Vasodilator Injection Using Dilated Over-the-Wire Balloon for Slow-Flow Phenomenon After Drug-Coated Balloon for Superficial Femoral Artery Occlusion.

Endovascular Perclose ProGlide complication puncture site, treated successful by cutting balloon dilatation: A case report and literature review.

Perclose ProGlide were created as preferred for puncture site closure of femoral artery. Femoral artery occlusion is one of the serious device-related complications. This report presents a continuous endovascular technique combined with peripheral cutting balloon (PCB) treatment for a case of a 32s woman diagnosed with lower extremity ischaemia caused by right superficial femoral artery (SFA) occlusion following the use of the Perclose ProGlide system in minimally invasive cardiac surgery. During the primary operation, limb ischaemia symptoms were relieved with vessel perfusion and reconstruction after regular balloon dilatation. A secondary operation was conducted 6 weeks later, and the obstructive lesions were recanalised without residual stenosis after PCB dilatation. No vessel-related adverse events such as dissection, rupture or distal embolisation occurred during the perioperative period. The patient recovered uneventfully after the operation, with complete alleviation of symptoms. Follow-up computed tomography angiography 3 month post-operatively revealed an undeformed shape and excellent patency of the right SFA.

Superficial Femoral Artery Atherosclerosis Masquerading as Sciatica: Diagnosis and Conservative Management – A Case Report

BACKGROUND: Often misdiagnosed as sciatica, vascular disorders such as peripheral arterial disease (PAD) can lead to a decreased quality of life. CASE PRESENTATION: The patient was a 44-year-old female referred to physical therapy with diagnosis of right-sided sciatica and L5-S1 degenerative disc disease, reporting right hip pain radiating into the thigh and foot, and worsening calf cramping. Based on inconsistent exam findings with lumbar spine imaging, patient comorbidities, and medication review, there was suspicion of PAD. The patient was referred to vascular surgery with recommendation of arterial ultrasound evaluation per American College of Radiology imaging guidelines. OUTCOME AND FOLLOW-UP: Arterial duplex revealed moderate arterial insufficiency with right distal superficial femoral artery occlusion. Patient underwent a 12-week supervised exercise program using the Gardner-Skinner Protocol for conservative management. DISCUSSION: Recognizing clinical presentation of arterial pathology, knowledge of imaging guidelines, and interdisciplinary care are essential for optimal management of PAD, particularly in cases with atypical risk factors. JOSPT Cases 2024;4(1):22-29. Epub 8 January 2024. doi:10.2519/josptcases.2024.12102

Use of Retrograde Outback Catheter Through the Pedal Route in a Stumpless Long Superficial Femoral Artery Occlusion

Use of Retrograde Outback Catheter Through the Pedal Route in a Stumpless Long Superficial Femoral Artery Occlusion

Retrograde recanalization for chronic superficial femoral artery occlusion: is it safe and effective as a primary strategy

Amaç: Periferik arter hastalığı (PAH), dünya çapında koroner arter hastalığı ve serebrovasküler olaylardan sonra en sık görülen mortalite ve morbidite nedenlerinden biridir. Kronik tıkalı yüzeyel femoral arter (SFA)’in endovasküler tedavisi (EVT) genellikle antegrad yaklaşımla yönetilir. Retrograd popliteal erişim (RPA), antegrad girişimin başarısız olduğu veya birincil seçenek olarak tercih edildiği durumlarda değerli bir seçenektir. Birinci basamak strateji olarak yüzüstü pozisyonda RPA'nın seçildiği ve rekanalizasyon için perkütanöz kasıtlı ekstralüminal anjiyoplasti (PIER) tekniğinin kullanıldığı hastaları, ileriye doğru girişimin başarısız olduğu ve sırtüstü pozisyonda RPA'nın kullanıldığı hastaları karşılaştırmayı amaçlıyoruz. 15 aylık takip ile rekanalizasyon için çift yönlü “randevous” tekniği kullanıldı.&#x0D; Gereç ve yöntemler: Şubat 2017 ile Nisan 2019 arasında ardışık EVT'leri retrospektif olarak inceledik ve SFA lezyonlarının CTO'sunun rekanalizasyonu için RPA'nın kullanıldığı tüm EVT'leri seçtik. Çalışma, hastaları Grup 1 (n=24) olarak iki gruba ayırdı: Birinci basamak strateji olarak yüzüstü pozisyonda RPA'nın seçildiği ve rekanalizasyon için PIER tekniğinin kullanıldığı hastalar (6F Sheat ile) ve Grup 2 (n= 22): Antegrad girişimin başarısız olduğu ve endolüminal rekanalizasyon ile sırtüstü pozisyonda RPA'nın olduğu veya lezyonu geçerken telin başarısız olduğu hastalar, rekanalizasyon için çift yönlü “çift balon (randevu)” tekniği kullanıldı (Kılıfsız).&#x0D; Bulgular: Teknik başarı oranı %100 oldu. RCC ve ABI her iki grupta da işlem sonrası anlamlı düzeyde iyileşti. Grup 1'de daha fazla hastaya primer stent gerekti (%70,8 vs. %45,4; p0,05). 1 yıllık uzuv kurtarma oranı her iki grup için de 100 ± 0 idi. Grup 2'de primer açıklık oranları grup 1'e göre daha yüksekti ancak bu fark ancak 6. ayda anlamlı hale geldi (grup 1'de sırasıyla %95,8, %87,5, %79,1'e karşı grup 2'de sırasıyla %100, %95,4, %81,8); p

Case Report of Stent Revascularization for Left Superficial Femoral Artery Occlusion

Patients with intermittent claudication may benefit from planned exercise therapy prior to revascularization, whereas those experiencing acute limb ischemia-a medical emergency-need revascularization within hours. The urgency of revascularization varies greatly depending on the patient's presentation. Peripheral artery disease (PAD) can cause symptoms ranging from severe evidence of ischemia (tissue loss, pain during rest) to intermittent claudication, or pain during walking. The author reports the case of a 72-year-old male patient who underwent a stent revascularization (angioplasty) for claudication due to left superficial femoral artery occlusion. The aim of this article is to present the importance of south-south cooperation between Gabon where vascular surgery is not available and Morocco where it is available. Moreover, the author wanted to put the emphasis on the development of partnership with some private clinics in Gabon to develop such surgery.

A patient with acute myocardial infarction with acute lower extremity arterial embolization underwent amputation under general anesthesia.

Acute peripheral and coronary artery embolism are common complications of diabetes mellitus and greatly affect the clinical outcome of patients with diabetes; however, there are few reports about the symptoms and prognosis of patients with acute myocardial infarction (AMI) and concurrent acute lower extremity arterial embolism (ALEAE). A 44-year-old man with a history of 4 years of type 1 diabetes was admitted to hospital after suddenly experiencing severe pain in his right lower limb and feeling tightness in the left anterior chest area. Ultrasonography revealed distal occlusion of the right superficial femoral artery, and an electrocardiogram showed acute anterior interstitial myocardial infarction. After conservative treatment for 2 days, the patient had severe necrosis of the lower limbs and secondary injury of multiple organs. Haemodialysis and heparin anticoagulant therapy were performed before amputation. Twelve days after the operation, the patient's condition was stable, and he was transferred out of the intensive care unit. If patients with ALEAE miss the opportunity for early treatment, even with AMI, emergency amputation under general anaesthesia is the right strategy to save lives.

JET+PCB strategy in the treatment of superficial femoral artery occlusion: a case report

Сritical limb ischemia (CLI) is becoming more and more common among patients worldwide. This is a comorbid condition, which is accompanied by chronic pain, sometimes trophic ulcers and gangrene, as well as a decrease in the quality of life. Despite the chronic nature of ischemia, the absence of treatment is accompanied by a high incidence of limb amputation and death. Patients with lower limb atherosclerosis had the higher risk of cardiovascular events and death. This publication proposes to consider minimally invasive interventional arterial revascularization in a 63-year-old patient with intermittent claudication, stage III critical limb ischemia, with a history of bilateral superficial femoral artery (SFA) stenting. Control lower limb angiography showed bilateral SFA occlusion and thrombosis. Taking into account the restenosis of the previously implanted stent, JET+PCB strategy was considered: first stage — rotational atherectomy followed by SFA angioplasty with a drug-eluting balloon catheter. The correct choice of minimally invasive surgery method in combination with non-pharmacological (smoking cessation, training walking) and pharmacological methods made it possible to restore viability and preserve the lower limb without negative consequences for the patient's health.

Endovascular Approach to Complex CTO Lesion in a Poor Surgical Candidate

Despite the various uses of endovascular and surgical techniques in management of patients with critical limb ischemia (CLI), traditional open bypass surgery with vein graft was shown to be more durable in the long term in long segment and heavily calcified lesions per the Best-CLI trial. However, patients with extensive cardiovascular risk factors and poor surgical candidates benefit from an endovascular approach. Endovascular revascularization of long segment lesions is complex and often requires the use of multiple unique techniques. Here, we present a case of a 76-year-old male with complex cardiovascular history with history of partial amputation of the right great toe and fifth toe who presented with non-healing ulcers overlying the right first and fifth distal metatarsals. A 76-year-old man with complex cardiovascular history presented with limited mobility, rest pain, and non-healing ulcers overlying the right first and fifth distal metatarsals. Bilateral common femoral artery (CFA) endarterectomy and lower left extremity angioplasty with stenting was done in the past. Doppler studies demonstrated dampened and flat pulses throughout the right lower extremity. Current computed tomography angiography (CTA) showed occlusion of the right superficial femoral artery (SFA) from the ostium to the P3 segment of the popliteal artery with significant calcification. Through ultrasound-guided left CFA access, a .035 guidewire and sheath were advanced into right distal CFA/proximal SFA and with angiogram confirming CTA results. Through the ultrasound-guided right PTA access and double flossing technique, retrograde V-18 guidewire was advanced into the antegrade Navicross catheter positioned within the right CFA. Subsequently, over the guidewire orbital atherectomy and balloon angioplasty were performed from the distal CFA to the proximal ATA region. With use of intravascular ultrasound for vessel diameter measurement, self-expanding stents were placed from the proximal SFA to the distal popliteal region. Final angiogram demonstrated an improvement of luminal diameter with less than 30% stenosis through the right lower extremity. Patient was started on Xarelto and aspirin. Multimodal endovascular technical approaches such as double-crossing flossing technique, controlled antegrade and retrograde tracking (CART) and reverse CART technique, and synapse rendezvous technique help with management of complex long segment occlusions. The case above demonstrates the use of double-crossing flossing technique in successful revascularization of a patient with end-stage CLI.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Duplex-Guided Ipsilateral Antegrade Approach for Flush Superficial Femoral Artery Occlusion.

Recanalization of flush ostial superficial femoral artery (SFA) occlusion is a very challenging procedure. Using the ipsilateral antegrade approach in such lesions has some difficulties. This study aimed to assess the feasibility, efficacy, and outcomes of duplex-guided ipsilateral antegrade access for endovascular treatment of atherosclerotic flush occlusion of the SFA. This is a prospective two-center study that included chronic lower extremity ischemia patients with flush occlusion of SFA who underwent duplex-guided ipsilateral antegrade endovascular revascularization due to unfeasible contralateral femoral approach. Flush occlusions were preoperatively documented by duplex ultrasound and computed tomography angiography in all patients. The outcome measures were technical success, patency rates, perioperative morbidity and mortality, limb salvage, and amputation free survival rates. Between April 2019 and March 2021, 49 patients were enrolled in the current study with a mean age of 63.7 ± 5.7years. Diabetes was the most common risk factor and was found in 40 (81.6%) patients. Associated popliteal lesions were found in seven (14.3%) patients, while 10 (20.4%) patients had combined tibial disease. Selective stenting was done in nine (18.4%) patients. Technical success was achieved in 43 (87.8%) patients. All failures were due to inability to cross the lesion rather than failure to access the common femoral artery. All complications were minor and occurred in seven (14.3%) patients. Primary, assisted primary, and secondary patency rates were 63.9% ± 7.1%, 82.8% ± 5.6%, and 93.5% ± 3.7% at 12months, respectively. The overall 12-month limb salvage and amputation free survival rates were 91.8% and 83.3% ± 5.4%, respectively. Duplex-guided ipsilateral antegrade femoral access is a feasible, safe, and effective endovascular treatment option for flush SFA occlusion when contralateral femoral access is not possible.

A Case of Cauterized Tissue Using Laser Photoablation for In-Stent Occlusion of Superficial Femoral Artery

A Case of Cauterized Tissue Using Laser Photoablation for In-Stent Occlusion of Superficial Femoral Artery

Endovascular Treatment of Superficial Femoral Artery Ostial Occlusions and Outcomes of Unexpected Postprocedural Deep Femoral Artery Occlusion

Introduction: This study aimed to demonstrate different revascularization approaches to superficial femoral artery (SFA) ostial occlusion and to evaluate the outcomes of unexpected deep femoral artery (DFA) occlusion encountered during the endovascular treatment (EVT). Materials and Methods: This retrospective study included 56 patients diagnosed with ostial SFA occlusion between March 2014 and December 2019. Patients were divided into two groups: the percutaneous transluminal balloon angioplasty (PTA) group, which included 32 patients treated with PTA, and the stent group, which included 24 patients treated with stents. The preferred access site was the contralateral femoral approach, and in 20 patients, access was performed with the popliteal artery (n: 13), pedal arteries (n: 4), and retrograde occluded SFA (n: 3). Results: Technical success was 100%. In the PTA group and stent group, primary patencies were 81%, 75%; 62%, 66%; and 56%, 58% and secondary patencies were 92%, 90%; 64%, 63%; and 50%, 54% at 6, 12, and 24 months, respectively, with no significant differences determined between the groups (P = 0.943 and P = 0.640 by log-rank). DFA occlusion occurred in 8 patients during the EVT. Rutherford score was a statistically significant decrease in both the groups (Wilcoxon signed-rank test, P = 0.010). Conclusion: Even in challenging SFA ostial lesions, using several different approaches has high success rates in EVT. This study showed no significant difference in PTA and stenting patency rates. Accidentally, DFA occlusion may be encountered, in which case revascularization of the SFA is the priority, even if the procedure ends with occluded DFA. A patent SFA and good distal flow will be sufficient for foot perfusion in DFA’s occluded patients.

Post-Covid-19 Recurrent Lower Limb Ischemia in Healty Young Patient

Background: Although SARS-CoV-2 infection is primarily a respiratory illness, complications such as arterial and venous thromboembolism have been reported during acute infection and in the period after its resolution.Methods: We report the case of a 33-year-old male, previously healthy patient with acute recurrent unilateral arterial thrombosis of the leg occurring one month after a mild Covid-19 infection.Results: The patient has recently been diagnosed with essential hypertension and did not have other known risk factors for arterial thrombosis. He presented to the Emergency Department with a pale left foot and absent dorsal pedal pulse and after confirmed arterial occlusion by Doppler ultrasound, he underwent urgent thromboembolectomy. The following day a computed tomography angiogram showed recurrent thrombosis of the superficial femoral artery which was then resolved in an Angio-suite by balloon dilatation. Three months later he experienced another occlusion of the left superficial femoral artery based on pronounced neointimal hyperplasia and again underwent endarterectomy with patch plastic.Conclusion: SARS-Cov-2 infection should be considered a risk factor in the development of both arterial and venous thrombo-sis during the acute phase and in the post-infective period