Anatomical merkmal method for anterolateral popliteal artery puncture technique: A prospective study

In the treatment of chronic total occlusion of the superficial femoral artery, distal puncture is sometimes required, and the anterolateral popliteal puncture (PA) technique has many advantages, such as the feasibility of performing the puncture in the supine position and easy preparation. We retrospectively investigated whether there is an anatomical merkmal that can facilitate this puncture method using contrast-enhanced lower limb CT and reported the findings. In this study, we prospectively investigated whether the merkmal method can be used in actual angiography. The method was to rotate the tube 45° outwards, rotate the leg inwards so that the fibula and tibia were farthest apart, place the clip in the area where the PA was expected to be, assuming that it ran along the medial edge of the fibular head, and then inject the contrast medium. The concordance rate of this method was defined as the percentage of the area of the PA overlapped by the paper clip divided by the area of the PA, which was defined as the primary endpoint. The secondary endpoint was the percentage of PA running between the fibula and tibia at the fibular head level. The result for the primary endpoint was 43.8 (0-79.8) % and for the secondary endpoint, 94.4 % of the PA was between the fibula and tibia. Although this method is not recommended for completely blind puncture, it is effective in facilitating puncture, conserving contrast, and improving puncture accuracy.