Femoral Balloon-Oriented Puncture for True Lumen Reentry in the Common Femoral Artery After Subintimal Retrograde Recanalization of Superficial Femoral Artery Ostial Occlusion: The FORLEE Technique

Purpose: To report a new technique to reenter the common femoral artery (CFA) true lumen after retrograde recanalization of a superficial femoral artery (SFA) with flush ostial occlusion. Technique: The technique is demonstrated in a 76-year-old woman with critical limb ischemia previously submitted to several surgical revascularizations. A duplex ultrasound showed flush ostial occlusion of the SFA and patency of the anterior tibial artery at the ankle as the sole outflow vessel. After unsuccessful antegrade attempts to recanalize the SFA, a retrograde guidewire was advanced subintimally up to the CFA, without gaining reentry. A balloon catheter was inflated in the subintimal plane across the SFA ostial occlusion. Antegrade access to the distal CFA was achieved with a 20-G needle, which was used to puncture the balloon. A guidewire was advanced into the balloon and pushed forward while the collapsed balloon was pulled back to the mid SFA. The antegrade guidewire was externalized through a retrograde catheter, which was pushed in the CFA true lumen. A retrograde guidewire was advanced and externalized through the femoral sheath, establishing a flossing wire. The procedure was completed in antegrade fashion. Conclusion: The FORLEE technique is a cost-effective option to gain the CFA true lumen after subintimal retrograde recanalization of an ostial SFA occlusion.

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Endovascular Treatment of the Common Femoral Artery for Limb Ischemia

Vascular and Endovascular Surgery ◽

10.1177/1538574413500723 ◽

2013 ◽

Vol 47 (8) ◽

pp. 639-644 ◽

Cited By ~ 16

Author(s):

Robert S. M. Davies ◽

William Adair ◽

Amman Bolia ◽

Guy Fishwick ◽

Robert D. Sayers ◽

...

Keyword(s):

Endovascular Treatment ◽

Femoral Artery ◽

Limb Ischemia ◽

Common Femoral Artery ◽

The Common

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A Combined Radial and Pedal Access to Treat a Flush Chronic Total Occlusion of the Superficial Femoral Artery in a Critical Limb Ischemia Patient

Open Journal of Cardiovascular Surgery ◽

10.1177/1179065219834523 ◽

2019 ◽

Vol 11 ◽

pp. 117906521983452

Author(s):

Nicolas W Shammas ◽

Qais Radaideh

Keyword(s):

Femoral Artery ◽

Critical Limb Ischemia ◽

Superficial Femoral Artery ◽

Chronic Total Occlusion ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Retrograde Approach ◽

Total Occlusion ◽

Radial Approach ◽

Antegrade Approach

We present a case of a flush chronic total occlusion of the superficial femoral artery treated successfully with a combined antegrade approach using radial access and a retrograde approach using a pedal access. Patient has total occlusion of the contralateral left external iliac and common femoral artery. Our case illustrates the feasibility of the combined pedal-radial approach in treating flush occlusions of the superficial femoral artery.

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Common Femoral Artery Access: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa192 ◽

2020 ◽

Vol 19 (6) ◽

pp. E594-E594

Author(s):

Maureen A Darwal ◽

Mandy J Binning ◽

Mark Bain ◽

Bernard Bendock ◽

Alan S Boulos ◽

...

Keyword(s):

Vascular Access ◽

Femoral Artery ◽

Cerebral Angiography ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Retroperitoneal Hematoma ◽

Anatomic Landmarks ◽

The Common ◽

Groin Hematoma ◽

Safe Access

Abstract Vascular access for cerebral angiography has traditionally been performed via the common femoral artery. It is crucial to obtain safe access to prevent complications that could lead to limb ischemia, groin hematoma, or retroperitoneal hematoma. This is especially true in neurointervention as many patients are anticoagulated or have received intravenous thrombolytics prior to their intervention. Special attention to anatomic landmarks, both grossly and radiographically, can help to assure safe access. The patient consented for this procedure. This video details rapid but safe femoral artery access in a patient undergoing emergent thrombectomy.

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Case report of superficial femoral artery and popliteal artery aneurysm repair using brachial vein

Vascular ◽

10.1177/17085381211019588 ◽

2021 ◽

pp. 170853812110195

Author(s):

Nikita Singh ◽

Ronak Patel ◽

Anil Hingorani ◽

Enrico Ascher

Keyword(s):

Lower Extremity ◽

Femoral Artery ◽

Superficial Femoral Artery ◽

Popliteal Artery ◽

Bypass Surgery ◽

Artery Aneurysm ◽

Duplex Ultrasound ◽

Anterior Tibial Artery ◽

Popliteal Artery Aneurysm ◽

Brachial Vein

Background Several veins have been well-recognized as acceptable conduits for infrainguinal bypass surgery when the ipsilateral greater saphenous vein is unavailable. However, there is a paucity of literature describing the brachial vein as an adequate alternative. In the absence of other viable autogenous conduits, we describe the use of a brachial vein as a successful alternative for lower extremity revascularization. Methods A 70-year-old man presented with a chief complaint of right calf pain. Duplex ultrasound imaging of his right lower extremity revealed right-sided 2.5 cm acutely thrombosed superficial femoral artery and popliteal artery aneurysms. The patient underwent a suction thrombectomy with tissue plasminogen activator using the Power Pulse feature and Solent catheter from the AngioJet® (Boston-Scientific, Marlborough, MA) system. To repair the thrombosed aneurysms, an open bypass was planned. Due to lack of viable alternative traditionally used venous conduits, a bypass was created using the patient’s brachial vein. Results A bypass was created from the superficial femoral artery to the P2 segment of the popliteal artery using a non-reversed brachial vein with ligation of the side branches of the superficial femoral artery and popliteal artery aneurysm from within the sac lumen. Completion angiogram revealed runoff through the anterior tibial artery only. Follow-up imaging at three months demonstrated a patent brachial bypass. Conclusion Brachial veins can be safely used as viable venous conduits for lower extremity bypass surgery and should therefore be considered as an alternative when more commonly used veins are unsuitable or unavailable. However, more research is needed to determine the potential opportunities and challenges this alternative may present.

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Feasibility and Safety of Vascular Closure Devices in an Antegrade Approach to Either the Common Femoral Artery or the Superficial Femoral Artery

CardioVascular and Interventional Radiology ◽

10.1007/s00270-012-0454-5 ◽

2012 ◽

Vol 35 (5) ◽

pp. 1036-1040 ◽

Cited By ~ 22

Author(s):

Andreas Gutzeit ◽

Bram van Schie ◽

Eric Schoch ◽

Klaus Hergan ◽

Nicole Graf ◽

...

Keyword(s):

Femoral Artery ◽

Superficial Femoral Artery ◽

Common Femoral Artery ◽

Antegrade Approach ◽

Vascular Closure Devices ◽

The Common

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Kissing Stents in the Common Femoral Artery Bifurcation for Critical Limb Ischemia: Technical Description and Report of Three Cases

Vascular ◽

10.2310/6670.2007.00037 ◽

2007 ◽

Vol 15 (4) ◽

pp. 211-214 ◽

Cited By ~ 12

Author(s):

Sven Ross Mathisen ◽

Michael Åkesson ◽

Mats Lindh ◽

Krassi Ivancev ◽

Timothy A. Resch

Keyword(s):

Femoral Artery ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Short Term ◽

Number Of Patients ◽

The Common ◽

Kissing Stent ◽

Patch Plasty

The purpose of this article is to describe three cases of kissing stent placement in the common femoral artery bifurcation in patients unsuitable for open endarterectomy and patch plasty. In three patients with critical limb ischemia, caused by primary atherosclerotic disease or dissection-related injury when performing a lower extremity intervention, a technique of kissing stents was used to treat the flow-obstructing lesion in the common femoral artery bifurcation. Technical success was uniform, and during follow-up (4.5–8 months), all patients showed improved symptoms, wound healing, and duplex ultrasonography–verified patency of the stents. Kissing stents in the common femoral artery bifurcation are a feasible treatment option in patients with limited mobililty or contraindications to open repair. The short-term results seem promising, but longer follow-up and an increased number of patients will be needed to assess the durability of the reconstruction.

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Tunneled Ipsilateral Sheath: A Novel Technique in Endovascular Management of Superficial Femoral Artery Ostial Lesions

Vascular and Endovascular Surgery ◽

10.1177/1538574418823593 ◽

2019 ◽

Vol 53 (4) ◽

pp. 337-340

Author(s):

Mohamed I. EL-Maadawy ◽

Ahmed M. Balboula ◽

Hossam Zaghloul

Keyword(s):

Femoral Artery ◽

Superficial Femoral Artery ◽

Common Femoral Artery ◽

Endovascular Management ◽

Novel Technique ◽

Antegrade Approach ◽

Technical Details ◽

Subcutaneous Tunnel ◽

The Common ◽

Ostial Lesion

Ostial lesions of the superficial femoral artery preclude the use of ipsilateral common femoral artery antegrade approach. Access via either the contralateral common femoral or the brachial arteries are the 2 alternative classical approaches. Conversely, using an ipsilateral antegrade approach, through a partially inserted sheath, usually leaves the sheath insecure and frequently hits ostial lesion itself during insertion. Dislodgment from the artery frequently occurs, resulting in loss of access. We describe a technique whereby we insert 2 to 3 cm of the sheath into the common femoral artery and the remaining part of the sheath resides in a fashioned subcutaneous tunnel of the lowermost abdomen. Technical details are provided as well as the results of using this technique on 37 patients. The technique is safe, easy to perform, and reproducible.

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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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