Percutaneous Mechanical Thrombectomy with Rotarex Using the Retrograde Posterior Tibial Artery Approach for Recanalization of Superficial Femoral Artery In-Stent Occlusion

Introduction. Retrograde pedal access has been well described in the literature as a secondary approach for limb salvage in critical limb ischemia (CLI) patients. In this manuscript we are presenting a case where retrograde tibiopedal access has been used as a bail-out procedure for the management of superficial femoral artery (SFA) intervention complications.Procedure/Technique. After development of a perforation while trying to cross the totally occluded mid SFA using the conventional CFA access, we were able to cross the mid SFA lesion after accessing the posterior tibial artery in a retrograde fashion and delivered a self-expanding stent which created a flap that sealed the perforation without the need for covered stent.Conclusion. Retrograde tibiopedal access is a safe and effective approach for delivery of stents from the distal approach and so can be used as a bail-out technique for SFA perforation.

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Endovascular Revascularization of Superficial Femoral Artery Stent Occlusion by Combined Retrograde Access With Catheter-Directed Thrombolysis and Pharmaco-Mechanical Thrombectomy

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2019.10.027 ◽

2020 ◽

Vol 21 (11) ◽

pp. 174-179

Author(s):

Muhammad Baig ◽

Hafiz M. Imran ◽

Herbert D. Aronow ◽

Omar N. Hyder

Keyword(s):

Femoral Artery ◽

Superficial Femoral Artery ◽

Mechanical Thrombectomy ◽

Stent Occlusion ◽

Endovascular Revascularization ◽

Catheter Directed Thrombolysis

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Precise Retrograde Supera Stenting of the Ostium (PRESTO) of the Superficial Femoral Artery for Complex Femoropopliteal Occlusions: The PRESTO Technique

Journal of Endovascular Therapy ◽

10.1177/1526602817753388 ◽

2018 ◽

Vol 25 (5) ◽

pp. 588-591 ◽

Cited By ~ 3

Author(s):

Luis M. Palena ◽

Larry J. Diaz-Sandoval ◽

Laiq M. Raja ◽

Luis Morelli ◽

Marco Manzi

Keyword(s):

Femoral Artery ◽

Superficial Femoral Artery ◽

Limb Ischemia ◽

Posterior Tibial Artery ◽

Anterior Tibial Artery ◽

Access Site ◽

Total Occlusion ◽

Arterial Access ◽

Tibial Artery ◽

Anterior Tibial

Purpose: To describe a novel technique designed to safely and precisely deploy the Supera stent accurately at the ostium of the proximal superficial femoral artery (SFA) without compromising the profunda and common femoral arteries. Technique: After antegrade crossing of the chronic total occlusion (CTO) at the SFA ostium and accurate predilation of the entire SFA lesion, a retrograde arterial access is obtained. The Supera stent is navigated in retrograde fashion to position the first crown to be released just at the SFA ostium. Antegrade dilation is performed across the retrograde access site to obtain adequate hemostasis. The technique has been applied successfully in 21 patients (mean age 78.1±8.2 years; 13 men) with critical limb ischemia using retrograde Supera stenting from the proximal anterior tibial artery (n=6), the posterior tibial artery (n=2), retrograde stent puncture in the mid to distal SFA (n=2), the native distal SFA/proximal popliteal segment (n=6), and the distal anterior tibial artery (n=5). No complications were observed. Conclusion: Distal retrograde Supera stent passage and reverse deployment allow precise and safe Supera stenting at the SFA ostium.

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