Two-Year Follow-Up After Endovascular Therapy of Superficial Femoral Arteries with Retrograde Popliteal Approach: Single-Center Experience

Abstract

Objective: Popliteal artery puncture, which makes possible the use of lower profile sheaths and devices, has gained popularity as an alternative to the antegrade approach, due to the reduction in vascular complications at the access site. The present study aimed to analyze the safety of the procedure and long-term patency of the superficial femoral artery (SFA) and popliteal artery (PA) and in subjects undergoing recanalization with the popliteal retrograde approach. Methods: Forty-three subjects, who underwent endovascular therapy (EVT) of the SFA or PA with retrograde popliteal approach, were enrolled in this retrospective study. The decision for the retrograde approach was made according to pre-intervention CT angiography results (severe calcification and relatively long CTO segment) in 20 of the subjects. The remaining 23 subjects underwent SFA or PA recanalization with the retrograde approach, due to failed antegrade recanalization attempt. All patients underwent color duplex ultrasound at the first, sixth, 12th, and 24th months to determine patency. The rate of procedural complications, including hematoma, bleeding, and distal embolism, were recorded for all subjects. Results: Technical success was achieved in all cases. Access site complications, including hematoma and bleeding, were observed in 2 subjects (4.66%). Transfusion or surgical treatments were not required in any cases with access site complications. The acute success rate was defined as the recovery of good blood flow evaluated by angiography after EVT was 100%. Distal embolization, which did not cause any limitations in distal flow, occurred in 1 subject (2.33%). Ankle-brachial index (ABI) calculated at 1 month post-intervention was significantly higher than pre-intervention ABI [0.9 (0.59 - 1.3) versus 0.7 (0.4 - 1.1), P < .001]. Patency rates, as determined by ultrasonographic assessment at post-interventional first, sixth, 12th, and 24th months, were 100%, 95.34%, 88.37%, and 86.04%, respectively. Conclusion: Our findings demonstrate that retrograde popliteal artery puncture can be used as a safe and effective technique for recanalization of SFA and PA stenosis and occlusions. The retrograde popliteal approach provides excellent long-term primary patency rates.