scholarly journals Guidelines adherence or chronic total occlusion recanalization of the superficial femoral artery with a stentless approach: The next frontier?

2019 ◽  
Vol 7 ◽  
pp. 2050313X1882344
Author(s):  
Christos Rammos ◽  
Tobias Radecke ◽  
Julia Lortz ◽  
Martin Steinmetz ◽  
Tienush Rassaf
Keyword(s):  
Intermittent Claudication ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Chronic Total Occlusion ◽  
Complication Rates ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Surgical Bypass ◽  
Guidelines Adherence

In patients with intermittent claudication and long chronic total occlusions of the superficial femoral artery, a primary surgical bypass or stenting is recommended. However, due to the invasive nature, high complication rates and patient-related comorbidities, surgery is currently not the preferred method and full lesion stenting for long chronic total occlusions has the obvious consequences of permanent metallic implants. We report a case of a patient with a long chronic total occlusion of the superficial femoral artery with intermittent claudication. Endorsing an endovascular-first strategy, he was treated via an antegrade and retrograde approach with a complete recanalization and a stentless treatment with rotational atherectomy and drug-coated balloons. We believe this is a feasible endovascular strategy for the treatment of long chronic total occlusions of the superficial femoral artery for patients refusing open surgery. Further investigations are needed to evaluate long-term clinical outcomes of these novel techniques.

scholarly journals Retrograde Popliteal Access for Challenging Superficial Femoral Artery Occlusion

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Georges Ibrahim ◽  
Sami Nabhani ◽  
Michel Feghaly
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Artery Occlusion ◽  
Complication Rates ◽  
Puncture Site ◽  
Safe Alternative ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Antegrade Approach ◽  
Arteriovenous Shunts

Retrograde popliteal access has long been established as an alternative to the antegrade approach to occlusive lesions in the superficial femoral artery (SFA). However, early reports with high complication rates (dissection, hematomas, aneurysms, and arteriovenous shunts at the puncture site) reduced enthusiasm for this technique. In recent years, with the development of thinner sheaths and low profile angioplasty devices, retrograde popliteal access has resurfaced as a viable technique, mostly in combination with or after failure of the more classical antegrade approach. In this retrospective study, we will report the safety and efficacy of the retrograde popliteal approach in the treatment of superficial femoral artery chronic total occlusions, in 13 consecutive patients between January 2017 and January 2021. The results showed 100% successful puncture of the popliteal artery and 100% successful recanalization and stenting of the superficial femoral artery with a total of 2 complications related to the puncture site and zero periprocedural mortality. In conclusion, the retrograde popliteal approach appears to be an effective and safe alternative to the common SFA complete total occlusion (CTO) treatment approach.

scholarly journals Percutaneous Treatment of Superficial Femoral Artery Total Occlusions: Single Center Experience

Acta Medica ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 30-35
Author(s):  
AHMET HAKAN ATEŞ ◽  
AYSU BAŞAK ÖZBALCI ◽  
SELİM KUL ◽  
MUSTAFA YENERÇAĞ ◽  
Metin Okşul ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Treatment Strategy ◽  
Percutaneous Treatment ◽  
Arterial Disease ◽  
Complication Rates ◽  
Total Occlusion ◽  
First Choice ◽  
Stenting Procedure

Objectives Superficial femoral artery (SFA) is the most commonly effected vessel in peripheral arterial disease (PAD) and SFA total occlusions constitute the 50% of PAD patients presenting with symptoms. In this study, we investigated our patients with SFA total occlusions who were treated with percutaneous treatment strategy.   Methods In this study, we included ambulatory patients who were admitted to our clinics due to symptomatic severe SFA total occlusion and underwent PTA or PTA + stenting procedure.The demographic findings of the patients, procedure details, complications and follow-up results were noted. Results Out of 67 patients, 62 (92.5%) underwent PTA or PTA + stenting procedure successfully for SFA total occlusions. Only one serious complication, acute renal failure resulting in death developed during hospitalization. The mean follow-up time after the procedure was 11.1±7.2 months. During this follow-up time 36 (58.1%) were asymptomatic.  Out of 26 patients who were symptomatic, only 6 of them underwent reintervention and 3 were recommended surgical intervention.   Conclusion Peripheral interventions for SFA total occlusions are being performed successfully in experienced centers with low complication rates as the first treatment strategy in PAD. Herein,we have presented our patients who underwent successful PTA and/or stenting procedure with   high success and low complication rates. Peripheral interventions should be the first choice for SFA total occlusions in experienced centers.  

Transradial versus tibiopedal access approach for endovascular intervention of superficial femoral artery chronic total occlusion

2018 ◽  
Vol 92 (7) ◽  
pp. 1338-1344 ◽  
Author(s):  
Apurva Patel ◽  
Roosha Parikh ◽  
WahWah Htun ◽  
Robert Bellavics ◽  
John T. Coppola ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Chronic Total Occlusion ◽  
Endovascular Intervention ◽  
Total Occlusion

scholarly journals TCTAP C-257 Retrograde Recanalization of Chronic Total Occlusion of Superficial Femoral Artery After Antegrade Dissection

2017 ◽  
Vol 69 (16) ◽  
pp. S348-S349
Author(s):  
Nai-Yu Chi ◽  
Chun-Yuan Chu ◽  
Po-Chao Hsu ◽  
Cheng-An Chiu ◽  
Ho-Ming Su ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Chronic Total Occlusion ◽  
Total Occlusion

Preoperative assessment of computerized tomography angiography to predict success for crossing long Trans-Atlantic Inter-Society Consensus D lesions using the optical coherence tomography catheter

Vascular ◽  
2017 ◽  
Vol 26 (4) ◽  
pp. 362-367 ◽  
Author(s):  
Ryan J Kim ◽  
Jamie B Smith ◽  
Todd R Vogel
Keyword(s):  
Optical Coherence Tomography ◽  
Lower Extremity ◽  
Computerized Tomography ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Plaque Morphology ◽  
Optical Coherence ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Computerized Tomography Angiography

Objectives Optical coherence tomography chronic total occlusion catheter, the Ocelot (Avinger Inc., Redwood City, CA), has been utilized to cross Trans-Atlantic Inter-Society Consensus D lesions. This study evaluated the preoperative computerized tomography angiography of chronic total occlusions in the superficial femoral artery to predict clinical success. Methods We reviewed all patients who underwent lower extremity procedures with the Ocelot catheter from June 2014 to August 2016. Patients who had a preoperative computerized tomography angiography were evaluated. Final outcomes, plaque morphology, lesion length, calcium surface area, lesion location, and patient characteristics were analyzed. Results A total of 107 patients underwent lower extremity interventions with the Ocelot catheter. Seventy patients had a preoperative computerized tomography angiography scan prior to lower extremity intervention and 77% (54) had Trans-Atlantic Inter-Society Consensus D lesions that were crossed. Mean age was 62.8 years and 68.6% were male. Mean chronic total occlusion length was 182.7 mm (170.8 mm crossed vs. 222.6 mm uncrossed, p = 0.03). Calcium distribution differed significantly ( p<.01): circumferential (14.8 vs. 12.5%); eccentric (85 vs. 62.5%); and complete calcium occlusion (0 vs. 25%) for lesions that were crossed and uncrossed, respectively. Significant differences ( p<.0001) were found when calcium occlusion was less than 50% (87 vs. 31%), 51–75% (9.3 vs. 31.2%), and 76–100% (3.7 vs. 37.5%). Total calcium length in crossed lesion was 51.6 mm, and 92.8 mm in uncrossed lesions ( p = 0.10). No significant differences were noted for patient gender, occlusion location (proximal, middle, and distal superficial femoral artery), and kidney function. Conclusion The Ocelot catheter is an effective method to cross long Trans-Atlantic Inter-Society Consensus D lesions. Superficial femoral artery lesions longer than 17 cm and focal plaque morphology, specifically a total cross-sectional area of calcium and a calcium surface area greater than 50% were most predictive of failure to cross Trans-Atlantic Inter-Society Consensus D superficial femoral artery lesions. Computerized tomography angiography is an effective tool to predict success for crossing chronic total occlusions using optical coherence tomography technology and a critical consideration for patient selection.

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