Subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) and rertograde access for critical limb
Nicholas J Hendricks1, Saher S Sabri2
1Department of Radiology, University of Virginia, Charlottesville, VA.
Insights
Retrograde access techniques offer a new approach for recanalizing chronic total occlusions, especially in critical limb ischemia patients unsuitable for surgery. This method aids in limb salvage when traditional antegrade approaches fail.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Critical limb ischemia (CLI) often affects patients with comorbidities, limiting surgical options.
- Chronic total occlusions (CTOs) present a significant challenge in revascularization, particularly when conventional antegrade approaches fail.
- Traditional bypass surgery may not be feasible due to patient comorbidities or inadequate distal landing zones.
Purpose of the Study:
- To describe the utility of retrograde access techniques for recanalizing CTOs in CLI patients.
- To evaluate the effectiveness of subintimal arterial flossing with antegrade-retrograde intervention (SAFR) when antegrade techniques are unsuccessful.
- To highlight the potential of these endovascular methods for limb salvage in patients with limited treatment options.
Main Methods:
- Utilizing retrograde access into the distal target vessel to facilitate recanalization of CTOs.
- Employing subintimal arterial flossing with antegrade-retrograde intervention (SAFR) for complex occlusions.
- Applying these techniques for flush superficial femoral artery occlusions and trifurcation vessel lesions.
Main Results:
- Retrograde access provides an alternative pathway for recanalization when antegrade true-lumen crossing is not possible.
- SAFR technique is effective when subintimal crossing occurs and antegrade re-entry fails.
- These advanced techniques enable successful revascularization and limb salvage in challenging cases.
Conclusions:
- Retrograde access and SAFR techniques are valuable tools for treating complex CTOs in CLI patients.
- These endovascular strategies expand treatment options for patients who are poor surgical candidates.
- Proficiency in these methods can significantly improve limb salvage rates and avoid amputation.
Abstract:
Retrograde access techniques involve the addition of a retrograde access into the distal target vessel to aid in recanalization of chronic total occlusions. Many patients with critical limb ischemia are also poor surgical candidates because of comorbidities or lack of suitable landing zone for bypass procedures. This approach may be helpful in the setting of chronic occlusions that cannot be crossed via conventional antegrade true-lumen approaches. Subintimal arterial flossing with antegrade-retrograde intervention technique can be used when the occlusion was crossed in the subintimal plane and antegrade re-entry techniques failed. It may also be useful for flush superficial femoral artery occlusions or those lesions that extend into the trifurcation vessels. Proficiency in these techniques allows limb salvage in patients who lack surgical options and would otherwise undergo amputation.
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