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Percutaneous Femoropopliteal Recanalization Using a Completely Transpedal/Transtibial Approach
Timothy W I Clark1, Micah M Watts2, Tak W Kwan3
1Section of Interventional Radiology, Department of Radiology, Penn Presbyterian Medical Center, University of Pennsylvania Medical Center, 39th and Market Streets, Philadelphia, PA, 19104, USA. timothy.clark@uphs.upenn.edu.
Insights
This study shows that a transpedal/transtibial approach is a viable option for femoropopliteal revascularization. This technique successfully treated severe leg artery disease without complications, offering an alternative when traditional access is limited.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Femoropopliteal revascularization is crucial for treating peripheral artery disease.
- Traditional access via the common femoral artery can be challenging in some patients.
- Minimally invasive techniques are increasingly explored to improve patient outcomes.
Observation:
- A novel approach utilizing exclusively pedal or tibial arteries for access was employed.
- Three patients with severe (Rutherford 3-4) femoropopliteal disease (TASC C/D lesions) underwent this technique.
- The approach facilitated successful revascularization in complex arterial occlusions and previously stented segments.
Findings:
- Successful revascularization was achieved in all three patients.
- Treatments included reentry and stenting for chronic superficial femoral artery occlusion, endograft revision of a popliteal artery stent, and stenting of a chronic SFA occlusion.
- Complete symptom resolution was observed in all patients.
- No complications related to the pedal/tibial puncture sites occurred.
Implications:
- The transpedal/transtibial approach offers a promising alternative access strategy for femoropopliteal revascularization.
- This technique expands treatment options for patients with limited or unsuitable femoral access.
- It may represent an important advancement in endovascular treatment for critical limb ischemia.
Purpose:
To report preliminary experience with femoropopliteal revascularization using a completely transpedal/transtibial approach.
Materials And Methods:
Three patients with Rutherford 3-4 disease underwent revascularization of TASC C/D lesions using a pedal/tibial artery as the only site of arterial access.
Results:
One patient with a chronic superficial femoral artery occlusion had continuity achieved to the common femoral artery using a dedicated reentry device and stenting; in a second patient, an occluded popliteal artery stent was successfully revised with an endograft; and in a third patient with morbid obesity, a chronic SFA occlusion was successfully stented. All patients experienced complete resolution of presenting symptoms; no puncture site complications were seen.
Conclusions:
Use of a pedal/tibial approach as the sole site of arterial access may become an important access technique for femoropopliteal revascularization when patients have limited femoral access options.
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