Retrograde recanalization of complex SFA lesions indications and techniques
1Vascular and Interventional Radiology Unit, Department of Radiological Sciences, "Sapienza" University, Rome, Italy - fabrizio.fanelli@uniroma1.it.
Insights
Retrograde recanalization is a safe and effective endovascular technique for complex femoropopliteal lesions when antegrade approaches fail. This method offers high success rates and improved patient outcomes with fewer complications.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Femoro-popliteal artery disease often presents as severe, diffuse stenoses or occlusions.
- Current guidelines advocate endovascular techniques for Rutherford class 4-6 patients with TASC C/D lesions.
- Advancements in endovascular devices enhance treatment efficacy.
Purpose of the Study:
- To evaluate the safety and efficacy of retrograde recanalization for complex femoropopliteal lesions.
- To explore variations in retrograde access techniques and their outcomes.
- To compare retrograde recanalization with antegrade approaches for challenging lesions.
Main Methods:
- Review of literature on retrograde recanalization techniques for femoropopliteal disease.
- Analysis of different access sites, including popliteal, distal superficial femoral, and tibial/pedal arteries.
- Assessment of techniques performed with patients in supine position.
- Evaluation of complication rates and success rates associated with retrograde approaches.
Main Results:
- Retrograde recanalization is indicated when antegrade recanalization fails or is not feasible.
- Various retrograde access techniques, including supine positioning, achieve high success rates.
- Improvements in technique and operator skill have reduced complications associated with popliteal puncture.
- Retrograde recanalization demonstrates a high rate of successful intraluminal recanalization.
Conclusions:
- Retrograde recanalization is a safe and effective option for complex femoropopliteal lesions.
- This technique is cost-effective, time-efficient, and improves treatment outcomes.
- It offers a valuable alternative to antegrade approaches in challenging cases.
Abstract:
Femoro-popliteal segment is often characterized by diffuse and severe steno-obstructive atheroclerotic disease. Most recent guidelines recommended endovascular techniques as a valid and safe treatment in highly symptomatic patients (Rutherford class 4 to 6) with complex femoropopliteal lesions (TASC C and D). Continuous technical development is increasing the efficacy of the endovascular technique with the introduction of new dedicated devices. In most complex situation also retrograde recanalization can be applied. The main indication to this technique is when conventional antegrade recanalisation fails or cannot be apply. The most common retrograde access is through the popliteal artery. However many operators do not like this approach due to the technical issue correlated to the patient position. Recently several reports have been published keeping the patient supine improving patient comfort and operator activity. This tehnique was also affected by several complications at the level of the popliteal puncture site, but those were resolved with the improvement of technique and operator skills. Hence several Authors described different variants of such technique (subintimal techniques, patient in supine position, puncture of the distal superficial femoral artery, tibial/pedal artery access) all obtaining an high rate of success with a low complication rate. In conclusion retrograde recanalization can be considered a safe and effective technique for complex femoral lesions. It is also less expensive than recanalisation devices, less time consuming and can increase the outcome due to the higher percentage of intraluminal recanalization.
