Top

CardioVascular and Interventional Radiology

Published in:

01-08-2014 | Clinical Investigation

Transpopliteal Stenting of Femoral Occlusions in Patients With Critical Limb Ischemia Using a 4-French System

Authors: Marlon Spreen, Ted Vink, Bob Knippenberg, Jim Reekers, Lukas van Dijk, Jan Wever, Randolph van Eps, Hans van Overhagen

Published in: CardioVascular and Interventional Radiology | Issue 4/2014

Abstract

Purpose

In many patients with critical limb ischemia (CLI), transfemoral endovascular recanalization is the preferred treatment. Transpopliteal treatment may be used in patients with inaccessible groins. This retrospective study regards transpopliteal stenting of superficial femoral artery (SFA) occlusions using a 4F system.

Materials and Methods

Eleven patients (4 male and 7 female [mean age 77 years]) underwent 12 attempts of transpopliteal recanalization of long SFA occlusions (Trans-Atlantic InterSociety Consensus B through D). All patients had CLI (Rutherford 4 to 6) and were nonoperable due to poor general condition. Indications for transpopliteal access were proximal/flush SFA occlusions (n = 5), failure of antegrade recanalization (n = 4), infected femoral–femoral crossover bypass (n = 2), and occlusion of both the native SFA and the femoral–popliteal bypass (n = 1). The popliteal artery was punctured under ultrasound guidance. Occlusions were recanalized subintimally, and 4F compatible stents were implanted.

Results

Technical success rate (<30 % residual stenosis) was achieved in 83 % of cases. In two patients, stent dislocation occurred while the sheath was removed. One arteriovenous fistula was successfully treated with additional stenting. During 6-month follow-up, there were no major amputations, and three patients died from nonrelated causes. Fifty percent of patients alive after 6 months improved to Rutherford score ≤3. The duplex restenosis (>50 %) rate at 6 months was 50 %.

Conclusion

Transpopliteal primary stenting of complex SFA lesions in CLI for a temporary bypass is now technically feasible using a 4F system. Technical results are promising. Clinical results after 6 months are acceptable when taking into consideration that this approach may be the last option for limb salvage.

Twine CP, Coulston J, Shandall A, McLain AD (2009) Angioplasty versus stenting for superficial femoral artery lesions. Cochrane Database Syst Rev 2:CD006767

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG et al (2007) Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 45(Suppl S):S5–S67PubMedCrossRef

Tønnesen KH, Sager P, Karle A, Henriksen L, Jørgensen B (1988) Percutaneous transluminal angioplasty of the superficial femoral artery by retrograde catheterization via the popliteal artery. Cardiovasc Interv Radiol 11(3):127–131CrossRef

Matsi PJ, Manninen HI, Söder HK, Mustonen P, Kouri J (1995) Percutaneous transluminal angioplasty in femoral artery occlusions: primary and long-term results in 107 claudicant patients using femoral and popliteal catheterization techniques. Clin Radiol 50(4):237–244PubMedCrossRef

Ye M, Zhang H, Huang X, Shi Y, Yao Q, Zhang L et al (2013) Retrograde popliteal approach for challenging occlusions of the femoral–popliteal arteries. J Vasc Surg 58(1):84–89PubMedCrossRef

Brountzos EN, Moulakakis KG, Avgerinos ED, Dalainas I, G Giannakopoulos T, Kakisis J et al (2011) Retrograde transpopliteal approach of iliofemoral lesions. Vasc Endovasc Surg 45(7):646–650CrossRef

Yilmaz S, Sindel T, Ceken K, Alimoğlu E, Lüleci E (2001) Subintimal recanalization of long superficial femoral artery occlusions through the retrograde popliteal approach. Cardiovasc Interv Radiol 24(3):154–160CrossRef

Evans C, Peter N, Gibson M, Torrie EP, Galland RB, Magee TR (2010) Five-year retrograde transpopliteal angioplasty results compared with antegrade angioplasty. Ann R Coll Surg Engl 92(4):347–352PubMedCentralPubMedCrossRef

Noory E, Rastan A, Schwarzwälder U, Sixt S, Beschorner U, Bürgelin K et al (2009) Retrograde transpopliteal recanalization of chronic superficial femoral artery occlusion after failed re-entry during antegrade subintimal angioplasty. J Endovasc Ther 16(5):619–623PubMedCrossRef

10.

Saha S, Gibson M, Magee TR, Galland RB (2001) Torrie EP (2001) Early results of retrograde transpopliteal angioplasty of iliofemoral lesions. Cardiovasc Interv Radiol 24(6):378–382CrossRef

11.

Yilmaz S, Sindel T, Lüleci E (2005) Ultrasound-guided retrograde popliteal artery catheterization: experience in 174 consecutive patients. J Endovasc Ther 12(6):714–722PubMedCrossRef

12.

Zaitoun R, Iyer SS, Lewin RF, Dorros G (1990) Percutaneous popliteal approach for angioplasty of superficial femoral artery occlusions. Cathet Cardiovasc Diagn 21(3):154–158PubMedCrossRef

13.

McCullough KM (1993) Retrograde transpopliteal salvage of the failed antegrade transfemoral angioplasty. Australas Radiol 37(4):329–331PubMedCrossRef

14.

Muradin GS, Bosch JL, Stijnen T, Hunink MG (2001) Balloon dilation and stent implantation for treatment of femoropopliteal arterial disease: meta-analysis. Radiology 221(1):137–145PubMedCrossRef

15.

Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S et al (1997) Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 26(3):517–538PubMedCrossRef

16.

Acin F, de Haro J, Bleda S, Varela C, Esparza L (2012) Primary nitinol stenting in femoropopliteal occlusive disease: a meta-analysis of randomized controlled trials. J Endovasc Ther 19(5):585–595PubMedCrossRef

Title: Transpopliteal Stenting of Femoral Occlusions in Patients With Critical Limb Ischemia Using a 4-French System
Authors: Marlon Spreen
Ted Vink
Bob Knippenberg
Jim Reekers
Lukas van Dijk
Jan Wever
Randolph van Eps
Hans van Overhagen
Publication date: 01-08-2014
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 4/2014
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-014-0891-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Transpopliteal Stenting of Femoral Occlusions in Patients With Critical Limb Ischemia Using a 4-French System

Abstract

Purpose

Materials and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2014

Splenomegaly-Associated Thrombocytopenia After Hepatic Yttrium-90 Radioembolization

Recurrent Cerebral Hyperperfusion Syndrome After Intracranial Angioplasty and Stenting: Case Report with Review of Literature

Novel Approach for Juxtarenal Aortic Occlusion Treatment: The Y-Guidewire Configuration for Aortic Bifurcation Reconstruction

Temporary Distal Balloon Occlusion for Hepatic Embolization: A Novel Technique to Treat What Cannot be Selected

Stereotactic Radiofrequency Ablation for Liver Tumors in Inherited Metabolic Disorders

Use of Percutaneous Aspiration Thrombectomy vs. Anticoagulation Therapy to Treat Acute Iliofemoral Venous Thrombosis: 1-year Follow-up Results of a Randomised, Clinical Trial