Duplex-Guided Ipsilateral Antegrade Approach for Flush Superficial Femoral Artery Occlusion

Abstract

Objective

Recanalization of flush ostial superficial femoral artery (SFA) occlusion is a very challenging procedure. Using the ipsilateral antegrade approach in such lesions has some difficulties. This study aimed to assess the feasibility, efficacy, and outcomes of duplex-guided ipsilateral antegrade access for endovascular treatment of atherosclerotic flush occlusion of the SFA.

Methods

This is a prospective two-center study that included chronic lower extremity ischemia patients with flush occlusion of SFA who underwent duplex-guided ipsilateral antegrade endovascular revascularization due to unfeasible contralateral femoral approach. Flush occlusions were preoperatively documented by duplex ultrasound and computed tomography angiography in all patients. The outcome measures were technical success, patency rates, perioperative morbidity and mortality, limb salvage, and amputation free survival rates.

Results

Between April 2019 and March 2021, 49 patients were enrolled in the current study with a mean age of 63.7 ± 5.7 years. Diabetes was the most common risk factor and was found in 40 (81.6%) patients. Associated popliteal lesions were found in seven (14.3%) patients, while 10 (20.4%) patients had combined tibial disease. Selective stenting was done in nine (18.4%) patients. Technical success was achieved in 43 (87.8%) patients. All failures were due to inability to cross the lesion rather than failure to access the common femoral artery. All complications were minor and occurred in seven (14.3%) patients. Primary, assisted primary, and secondary patency rates were 63.9% ± 7.1%, 82.8% ± 5.6%, and 93.5% ± 3.7% at 12 months, respectively. The overall 12-month limb salvage and amputation free survival rates were 91.8% and 83.3% ± 5.4%, respectively.

Conclusion

Duplex-guided ipsilateral antegrade femoral access is a feasible, safe, and effective endovascular treatment option for flush SFA occlusion when contralateral femoral access is not possible.

Keywords

duplex ultrasound chronic limb ischemia flush occlusion ipsilateral femoral access superficial femoral artery endovascular treatment

Get full access to this article

View all access options for this article.

References

Shi

Yao

Wang

, et al. Combined antegrade femoral artery and retrograde popliteal artery recanalization for chronic occlusions of the superficial femoral artery. J Vasc Interv Radiol. 2014;25(9):1363-1368. doi:10.1016/j.jvir.2014.02.006.

Fanelli

Lucatelli

Allegritti

Corona

Rossi

Passariello

. Retrograde popliteal access in the supine patient for recanalization of the superficial femoral artery: Initial results. J Endovasc Ther. 2011;18(4):503-509. doi:10.1583/11-3425.1.

Shammas

Radaideh

. 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 J Cardiovasc Surg. 2019;11:117906521983452. doi:10.1177/1179065219834523.

Chavarria

Kim

Azrin

Lee

. Retrograde use of frontrunner catheter in superficial femoral artery for flushing long segment occlusions involving distal common femoral artery. Ann Vasc Dis. 2017;10(1):70-73. doi:10.3400/avd.cr.16-00124.

Fukagawa

Mori

Hirano

. Feasibility of the novel proximal superficial femoral artery puncture technique to recanalize chronic total occlusions. Catheter Cardiovasc Interv. 2021;97(6):E852-E856. doi:10.1002/ccd.29316.

Rutherford

Baker

Ernst

, et al. Recommended standards for reports dealing with lower extremity ischemia: Revised version. J Vasc Surg. 1997;26(3):517-538. doi:10.1016/S0741-5214(97)70045-4.

Rocha-Singh

Zeller

Jaff

. Peripheral arterial calcification: Prevalence, mechanism, detection, and clinical implications. Catheter Cardiovasc Interv. 2014;83(6):212-220. doi:10.1002/ccd.25387.

Corvino

Catalano

de Magistris

, et al. Usefulness of doppler techniques in the diagnosis of peripheral iatrogenic pseudoaneurysms secondary to minimally invasive interventional and surgical procedures: imaging findings and diagnostic performance study. J Ultrasound. 2020;23(4):563-573. doi:10.1007/s40477-020-00475-6.

Geronemus

Peña

. Endovascular treatment of femoral-popliteal disease. Semin Intervent Radiol. 2009;26(4):303-314. doi:10.1055/s-0029-1242203.

10.

Pua

. Profunda anchor technique for ipsilateral antegrade approach in endovascular treatment of superficial femoral artery ostial occlusion. Cardiovasc Intervent Radiol. 2015;38(2):453-456. doi:10.1007/s00270-014-1039-2.

11.

EL-Maadawy

Balboula

Zaghloul

. Tunneled ipsilateral sheath: A novel technique in endovascular management of superficial femoral artery ostial lesions. Vasc Endovascular Surg. 2019;53(4):337-340. doi:10.1177/1538574418823593.

12.

Eleissawy

Elbarbary

Elwagih

Elheniedy

Santoso

Fourneau

. Ipsilateral antegrade angioplasty for flush superficial femoral artery occlusion versus open bypass surgery. Ann Vasc Surg. 2019;61:55-64. doi:10.1016/j.avsg.2019.05.062.

13.

Taneja

Tay

Dewan

, et al. Bare nitinol stent enabled recanalization of long-segment, chronic total occlusion of superficial femoral and adjacent proximal popliteal artery in diabetic patients presenting with critical limb ischemia. Cardiovasc Revascularization Med. 2010;11(4):232-235. doi:10.1016/j.carrev.2009.10.002.

14.

Met

Van Lienden

Koelemay

MJW

Bipat

Legemate

Reekers

. Subintimal angioplasty for peripheral arterial occlusive disease: A systematic review. Cardiovasc Intervent Radiol. 2008;31(4):687-697. doi:10.1007/s00270-008-9331-7.

15.

Airoldi

Faglia

Losa

, et al. Antegrade approach for percutaneous interventions of ostial superficial femoral artery: Outcomes from a prospective series of diabetic patients presenting with critical limb ischemia. Cardiovasc Revascularization Med. 2012;13(1):20-24. doi:10.1016/j.carrev.2011.10.003.

16.

Ghoneim

Younis

Elmahdy

Elwan

Khairy

. Endovascular intervention in flush superficial femoral artery occlusive disease: challenges and outcome. Ital J Vasc Endovasc Surg 2019;26(1):22-32. doi:10.23736/S1824-4777.18.01368-2.

17.

Faglia

Clerici

Airoldi

, et al. Revascularization by angioplasty of type D femoropopliteal and long infrapopliteal lesion in diabetic patients with critical limb ischemia: Are TASC II recommendations suitable? A population-based cohort study. Int J Low Extrem Wounds. 2012;11(4):277-285. doi:10.1177/1534734612463701.

18.

Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). Eur J Vasc Endovasc Surg. 2000;19(Suppl A):Si-xxviii, S1-S250. http://www.ncbi.nlm.nih.gov/pubmed/10957904

19.

Norgren

Hiatt

Dormandy

, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). Int Angiol. 2007;26(2):82-157. doi:10.1016/j.jvs.2006.12.037.

20.

Wei

Zhu

Zhang

Liu

Zhao

. Morphological characteristics of chronic total occlusion: Predictors of different strategies for long-segment femoral arterial occlusions. Eur Radiol. 2018;28(3):897-909. doi:10.1007/s00330-017-5003-9.