Total Occlusion Of Superficial Femoral Artery Research Articles

Endovascular Therapy of the Superficial Femoral Artery Via a Stand-Alone Transradial Access: A Single-Center Experience.

We describe our experience in transradial recanalization of the superficial femoral artery (SFA), and we provide a stepwise approach accounting for the patient's height and optimizing the yield of currently available devices. Fifteen patients with simple SFA disease, including 4 patients with total SFA occlusions <15 cm, were selected for stand-alone transradial recanalization. A 6F, 125-cm multipurpose guiding catheter was used to cannulate the limb of interest and support device delivery. The procedure was successful in all patients and consisted of balloon angioplasty (using 0.014″, 200-cm shaft monorail balloons) in all patients, and orbital atherectomy in 6 patients. We illustrate the steps and challenges of the transradial approach, namely the limited support in complex disease and the limited reach of current equipment. In patients with simple SFA disease, transradial recanalization appears feasible and safe but currently limited to balloon angioplasty ± orbital atherectomy. Proximal SFA stenting may be feasible in patients <160 cm in height.

TCT-681 Retrograde popliteal access interventions for chronic total superficial femoral artery occlusions

Vascular intervention of superficial femoral artery (SFA) chronic total occlusions (CTO) is sometimes unsuccessful when the CTO cannot be crossed antegradely via contralateral or ipsilateral femoral approach because the proximal CTO cap is fibrocalcific or a CTO “nubbin” is absent. We performed

Initial Clinical Experience with the Protégé EverFlex™ Long Self‐Expanding Nitinol Stent in the Superficial Femoral Artery

Clinical results following stent implantation in the superficial femoral artery (SFA) are limited due to restenosis, often caused by stent fractures. Therefore new stent devices are desirable. The present study details our initial experience with the routine use of the novel Protégé EverFlex long self-expanding nitinol stent for treatment of long SFA total occlusions or stenoses. Between February and March 2006 a total of 15 EverFlex nitinol stents were implanted in 12 patients with either total SFA occlusions (n = 9) or long stenoses (n = 3), mean lesion length 14.9 cm (+/- 10.4 cm). All patients presented with claudication stage Fontaine IIb (Rutherford category 3). Stent lengths were 10 cm (n = 6), 12 cm (n = 1), or 15 cm (n = 8), stent diameters were 6 mm (n = 14) and 7 mm (n = 1). Access was gained either by the crossover (n = 9), antegrade (n = 2), or popliteal approach (n = 1). After predilatation, stent placement and postdilatation were performed with 100% technical success. Clinical and apparative follow-up after 6-8 weeks indicated the absence of restenosis or reocclusion in all cases. The novel long self-expanding EverFlex nitinol stent (10 cm/12 cm/15 cm in length) exhibits excellent technical handling characteristics with good short-term clinical results. Mid-term and long-term clinical results as well as potential stent fractures need to be further examined.

Initial clinical experience with an IVUS-guided transmembrane puncture device to facilitate recanalization of total femoral artery occlusions.

Failure to recanalize chronic superficial femoral artery occlusions is frequently caused by subintimal passage of the occlusion with inability to re-enter the true lumen with the guide-wire. The present study details our initial experience with the Pioneer crossing device (Medtronic, Menlo Park, CA) to facilitate recanalization of total femoral artery occlusions. 25 consecutive patients (18 male, mean age 63 years) whose failed recanalization attempts of chronic superficial femoral artery occlusions (mean occlusion length 12.7 cm) with standard techniques were re-scheduled for a secondary recanalization procedure. The Pioneer crossing device is a 6.2F rapid exchange catheter, which tracks over a 0.014"-wire. A 20MHz phased array IVUS transducer is integrated into the tip of the catheter allowing visualization of the vessel morphology. Using the guidance of the IVUS cross-sectional image supported by colour-flow imaging, the true lumen is punctured with an integrated 24G needle allowing delivery of a second 0.014"-wire. Re-entry into the true lumen was successfully accomplished in all cases without complications. In 8 cases with severe calcification predilatation of the false channel was necessary to allow advancement of the Pioneer crossing device. Furthermore, in 7 patients with severe calcification multiple puncture attempts were necessary to penetrate the dissection membrane. A procedural success (<25% residual stenosis) could be achieved in all cases after predilatation and stenting of the occlusion with self-expanding nitinol stents. The Pioneer crossing device is an effective and save tool to facilitate true lumen re-entry during recanalization of total superficial femoral artery occlusions.

Laser Angioplasty of Totally Occluded Superficial Femoral Arteries Via a Percutaneous Popliteal Approach

Percutaneous laser hot‐tip recanalization of totally occluded superficial femoral arteries has previously been dependent on access to the superficial femoral artery via the common femoral artery. Certain subsets of disease do not permit this approach and thus make patients ineligible for this nonsurgical option. In order to extend the benefits of laser angioplasty to these patients, we have investigated the applicability of percutaneous popliteal artery puncture as an access point from which superficial femoral artery percutaneous laser balloon angioplasty can be performed. Twenty‐one procedures were performed on 20 patients with total superficial femoral artery occlusions. Eighteen had successful recanalization (85%). All 18 recanalized vessels were patent at 3 weeks post procedure. Minor complications which did not require surgical or medical intervention occurred in nine patients. We concluded that a percutaneous popliteal approach to laser angioplasty of a totally occluded superficial femoral artery can be safe and effective in selected patients.