Retrograde recanalization for chronic superficial femoral artery occlusion: is it safe and effective as a primary strategy

Year 2023, Volume: 14 Issue: 4, 782 - 797, 30.12.2023

Ali Baran Budak Eren Günertem Naim Boran Tümer Kanat Özışık Serdar Günaydın

https://doi.org/10.18663/tjcl.1402002

Abstract

Aim: Peripheral arterial disease (PAD) is one the most common cause of mortality and morbidity after coronary artery disease and serebrovascular event worldwide. Endovascular treatment (EVT) of chronic occluded superficial femoral artery SFA is generally managed by antegrade approach. Retrograde popliteal access (RPA) is a valuable option when antegrad attempt fails or has also been preferred as a primary choice. We aim to compare patients in whom RPA in prone position was chosen as a first-line strategy and percutaneous intentional extraluminal angioplasty (PIER) technique was used for recanalization, with patients in whom antegrade attempt had failed and RPA in supine position with either endoluminal or bidirectional “randevous” technique was used for recanalization with 15-month follow-up.
Material and Methods: We retrospectively studied consecutive EVTs between February 2017 and April 2019, and selected all EVTs in which RPA was used for the recanalization of CTO of SFA lesions were included. The study divided patients into two groups as Group 1 (n=24): patients in whom RPA in the prone position was chosen as a first-line strategy and PIER technique was used for recanalization (with 6F Sheat) and Group 2 (n=22): patients in whom antegrade attempt had failed and RPA in the supine position with endoluminal recanalization or if the wire failed while crossing the lesion, a bidirectional “double-balloon (rendezvous)” technique was used for recanalization (Sheatless).
Results: Technical success rate was %100. RCC and ABI were improved post procedurally in both groups significantly. Primary stenting was required in more patients in group 1(70.8% vs. 45.4%; p<0.05). In group 2, randevous technique was used in 9 patients (40.9%). There was not any significant difference between the groups in terms of 30-day, and 12-month MACE. There were no major amputations, stent fracture, and death. In the 12th month, no significant differences was found between the groups for amputation-free survival (95.8% vs. 95.4%; p>0.05) .1-year limb-salvage rate was 100 ± 0 for both groups. Primary patency rates of group 2 were higher than group 1, but this difference became significant only at 6th month (95,8%, 87.5%, 79.1% for group 1vs. 100%, 95.4%, 81.8% for group 2, respectively; p<0.05 only for 6th month). The 1-year CD-TLR rate was 17,25% for whole study group, group 1 seems to have more CD-revascularization procedures but it did not reach to a significant difference (95% Cl 20.8% to 13.7%).
Conclusion: The RPA techniques has their own advantage and disadvantages. Considering safety and effectiveness, either planned as a primary strategy or needed as a back-up plan, it should be in the portfolio of vascular surgeons.

Keywords

peripheral arterial disease, chronic total occlusion, retrograde popliteal access.

Kronik yüzeyel femoral arter tıkanıklığında retrograd rekanalizasyon: Birincil strateji olarak güvenli ve etkili mi?

Abstract

Amaç: Periferik arter hastalığı (PAH), dünya çapında koroner arter hastalığı ve serebrovasküler olaylardan sonra en sık görülen mortalite ve morbidite nedenlerinden biridir. Kronik tıkalı yüzeyel femoral arter (SFA)’in endovasküler tedavisi (EVT) genellikle antegrad yaklaşımla yönetilir. Retrograd popliteal erişim (RPA), antegrad girişimin başarısız olduğu veya birincil seçenek olarak tercih edildiği durumlarda değerli bir seçenektir. Birinci basamak strateji olarak yüzüstü pozisyonda RPA'nın seçildiği ve rekanalizasyon için perkütanöz kasıtlı ekstralüminal anjiyoplasti (PIER) tekniğinin kullanıldığı hastaları, ileriye doğru girişimin başarısız olduğu ve sırtüstü pozisyonda RPA'nın kullanıldığı hastaları karşılaştırmayı amaçlıyoruz. 15 aylık takip ile rekanalizasyon için çift yönlü “randevous” tekniği kullanıldı.
Gereç ve yöntemler: Şubat 2017 ile Nisan 2019 arasında ardışık EVT'leri retrospektif olarak inceledik ve SFA lezyonlarının CTO'sunun rekanalizasyonu için RPA'nın kullanıldığı tüm EVT'leri seçtik. Çalışma, hastaları Grup 1 (n=24) olarak iki gruba ayırdı: Birinci basamak strateji olarak yüzüstü pozisyonda RPA'nın seçildiği ve rekanalizasyon için PIER tekniğinin kullanıldığı hastalar (6F Sheat ile) ve Grup 2 (n= 22): Antegrad girişimin başarısız olduğu ve endolüminal rekanalizasyon ile sırtüstü pozisyonda RPA'nın olduğu veya lezyonu geçerken telin başarısız olduğu hastalar, rekanalizasyon için çift yönlü “çift balon (randevu)” tekniği kullanıldı (Kılıfsız).
Bulgular: Teknik başarı oranı %100 oldu. RCC ve ABI her iki grupta da işlem sonrası anlamlı düzeyde iyileşti. Grup 1'de daha fazla hastaya primer stent gerekti (%70,8 vs. %45,4; p<0,05). Grup 2'deki hastaların 9'unda (%40,9) randevöz teknik kullanıldı. Gruplar arasında 30 günlük ve 12 aylık MACE açısından anlamlı fark yoktu. Büyük bir amputasyon, stent kırılması ve ölüm yaşanmadı. 12. ayda amputasyonsuz sağkalım açısından gruplar arasında anlamlı fark bulunmadı (%95,8 vs. %95,4; p>0,05). 1 yıllık uzuv kurtarma oranı her iki grup için de 100 ± 0 idi. Grup 2'de primer açıklık oranları grup 1'e göre daha yüksekti ancak bu fark ancak 6. ayda anlamlı hale geldi (grup 1'de sırasıyla %95,8, %87,5, %79,1'e karşı grup 2'de sırasıyla %100, %95,4, %81,8); p<0,05 yalnızca 6. ay için). Tüm çalışma grubu için 1 yıllık CD-TLR oranı %17,25 idi, grup 1'de daha fazla CD revaskülarizasyon işlemi yapılmış gibi görünüyor ancak anlamlı bir farka ulaşılamadı (%95 Cl %20,8 ila %13,7).
Sonuç: RPA tekniğinin kendi avantaj ve dezavantajları vardır. Güvenlik ve etkinlik göz önüne alındığında, ister birincil strateji olarak planlanmış, ister yedek plan olarak ihtiyaç duyulmuş olsun, damar cerrahlarının portföyünde yer almalıdır.

Keywords

periferik arter hastalığı; kronik total tıkanıklık; retrograd popliteal erişim.

References

• Fowkes FG, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet.2013; 382(9901):1329-1340.
• Ueshima D, Ashikaga T, Shimura T, et al. Popliteal Retrograde Approach is Effective and Safe for Superficial Femoral Artery Chronic Total Occlusion. Ann Vasc Dis. 2015;8(3):220–226.
• Bracale UM, Vitale G 2 , Bajardi G, Narese D, Dinoto E et al. Use of the Directional Atherectomy for the Treatment of Femoro-Popliteal Lesions in Patients With Critical Lower Limb Ischemia. Transl Med UniSa. 2016. vol. 15 42-47. 1 Nov. 2016.
• Kinlay S. Management of Critical Limb Ischemia. Circ Cardiovasc Interv. 2016;9(2):e001946.
• Katsanos K, Spiliopoulos S, Reppas L, Karnabatidis D. Debulking Atherectomy in the Peripheral Arteries: Is There a Role and What is the Evidence?. Cardiovasc Intervent Radiol. 2017;40(7):964–977.
• Zeller T, Saratzis N, Scheinert D, et al. Non-randomized, prospective, multi-centre evaluation of the ABSOLUTE .035 peripheral self-expanding stent system for occluded or stenotic superficial femoral or proximal popliteal arteries (ASSESS Trial): acute and 30-day results. J Cardiovasc Surg (Torino) 2007; 48: 719-26.
• Kitrou P,Parthipun A, Diamantopoulos A, etal. Targeted true lumen re-entry with the Outback catheter: accuracy, success, and complications in 100 peripheral chronic total occlusions and systematic review of the literature. J Endovasc Ther. 2015;22:538–545.
• Sangiorgi G, Lauria G, Airoldi F, et al. Retrograde popliteal ac- cess as bail-out strategy for challenging occlusions of the su- perficial femoral artery: a multicenter registry. Catheter Cardiovasc Interv 2012;79:1188e93. 8.
• Tonnesen KH, Sager P, Karle A, Henriksen L, Jørgensen B. Per-cutaneous transluminal angioplasty of the superficial femoral artery by retrograde catheterization via the popliteal artery. Car-diovasc Intervent Radiol.1988;11(3):127-131.
• Meng Y, Zhang H, Huang X, Shi Y, Yao Q, et al. Retrograde Popliteal Approach for Challenging Occlusions of the Femoral-Popliteal Arteries. J Vasc Surg 2013 Jul;58(1):84-9.
• Trigaux JP, Van Beers B, De Wispelaere JF. Anatomic relationship between the popliteal artery and vein: a guide to accurate angio- graphic puncture. AJR Am J Roentgenol. 1991; 157:1259–1262.
• Kawarada O, Yokoi Y. Retrograde 3-French popliteal approach in the supine position after failed antegrade angioplasty for chronic superficial femoral artery occlusion. J Endovasc Ther. 2010;17:255–258.
• Evans C, Peter N, Gibson M, et al. Five-year retrograde transpopliteal angioplasty results compared with antegrade angioplasty. Ann R Coll Surg Engl. 2010;92:347–352.
• Kawarada O. Commentary: Miniaturized retrograde popliteal approach in a supine patient. J Endovasc Ther. 2011;18:510–512.
• Montero-Baker M, Schmidt M, Braunlich S, Ulrich M, Thieme M, et al. Retrograde Approach for Complex Popliteal and Tibioperoneal Occlusions. J Endovasc Ther 2008;15: 594–604.
• Fanelli F, Lucatelli P, Allegritti M, Corona M, Rossi P, et al. Retrograde Popliteal Access in the Supine Patient for Recanalization of the Superficial Femoral Artery: Initial Results. J Endovasc Ther 2011;18:503–509.
• Yilmaz S, Sindel T, Ceken K, Alimoğlu E, Lüleci E. Subintimal Recanalization of Long Superficial Femoral Artery Occlusions Through the Retrograde Popliteal Approach Cardiovasc Intervent Radiol. 2001 May-Jun;24(3):154-60.
• Tan M, Urasawa K, Koshida R, Haraguchi T, Kitani S et al. Anterolateral Popliteal Puncture Technique: A Novel Retrograde Approach for Chronic Femoropopliteal Occlusions. J Endovasc Ther. 2017 Aug;24(4):525-530.
• Bolia A. Subintimal angioplasty: The way forward. Intervention 1998; 2:47–52.
• Reekers JA, Bolia A. Percutaneous intentional extraluminal (subintimal) recanalization: How to do it yourself. Eur J Radiol 1998; 28: 192–198.
• Silvestro, Palena LM, Manzi M , Jabalera EG, et al. Anterolateral Retrograde Access to the Distal Popliteal Artery and to the Tibioperoneal Trunk for Recanalization of Femoropopliteal Chronic Total Occlusions. J Vasc Surg. 2018 Dec;68(6):1824-1832.
• Schmidt A, Bausback Y, Piorkowski M, Werner M, Braunlich S, Ulrich M, et al. Retrograde recanalization tech- nique for use after failed antegrade angioplasty in chronic femoral artery occlusions. J Endovasc Ther 2012;19:23-9.
• Shimada Y, Kino N, Yano K, et al. Transcollateral retrograde approach with rendezvous technique for recanalization of chronically occluded tibial arteries. J Endovasc Ther. 2012;19:620–626.
• Surowiec SM, Davies MG, Eberly SW, et al. Percutaneous angioplasty and stenting of the superficial femoral artery. J Vasc Surg. 2005; 42:822–825.
• Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000;31:S1-296.
• Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007;45(Suppl S): S5-67.
• Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997;26:517-38.
• Stoner MC, Calligaro KD, Chaer RA, Dietzek AM, Farber A, Guzman RJ, Hamdan AD, Landry GJ, Yamaguchi DJ; Society for Vascular Surgery. Reporting Standards of the Society for Vascular Surgery for Endovascular Treatment of Chronic Lower Extremity Peripheral Artery Disease J Vasc Surg. 2016 Jul;64(1):e1-e21.
• Smolock CJ, Anaya-Ayala JE, Kaufman Y, et al. Current efficacy of open and endovascular interventions for advanced superficial femoral artery occlusive disease. J Vasc Surg 2013;58:1267e75. e1-2.
• E. Selvin and T. P. Erlinger, “Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999- 2000,” Circulation, vol. 110, no. 6, pp. 738–743, 2004.
• Ko YG, Ahn CM, Min PK, et al. Baseline characteristics of a retrospective patient cohort in the Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Diseases (K-VIS ELLA) Registry. Korean Circ J 2017;47:469-76.
• Narins CR. Access strategies for peripheral arterial intervention. Cardiol J. 2009;16:88–97.
• Saha S, Gibson M, Magee TR, et al. Early results of retrograde transpopliteal angioplasty of iliofemoral lesions. Cardiovasc Intervent Radiol. 2001;24:378–382.
• Spinosa DJ, Leung DA, Harthun NL, et al. Simul- taneous antegrade and retrograde access for subintimal recanalization of peripheral arterial occlusion. J Vasc Interv Radiol. 2003;14:1449–1454.
• Scheinert D, Bra ̈unlich S, Scheinert S, et al. Initial clinical experience with an IVUS-guided transmembrane puncture device to facilitate recanalization of total femoral artery occlu- sions. EuroIntervention. 2005;1:115–119.
• Bausback Y, Botsios S, Flux J, et al. Outback catheter for femoropopliteal occlusions: imme- diate and long-term results. J Endovasc Ther. 2011;18:13–21.
• Shin SH, Baril D, Chaer R, et al. Limitations of the Outback LTD re-entry device in femoropop- liteal chronic total occlusions. J Vasc Surg. 2011;53:1260–1264.
• Narins CR. Access strategies for peripheral arterial intervention. Cardiol J. 2009;16(1):88-97.
• Wylie EJ, Binkley FM, Albo RJ. Femoropopliteal endarterectomy. Am J Surg 1964;108:215–21.
• Reekers JA, Kromhout JG, Jacobs MJHM (1994) Percutaneous inten- tional extraluminal recanalization of the femoropopliteal artery. Eur J Vasc Surg 8:723–728.
• London NJ, Srinivasan R, Naylor AR, Hartshorne T, Ratliff DA, Bell PR, Bolia A. Subintimal angioplasty of femoropopliteal artery occlusions: The long term results. Eur J Vasc Surg 1994; 8:148–155.
• Heenan SD, Vinnicombe SJ, Buckenham TM, Belli AM. Percutaneous transluminal angioplasty by retrograde subintimal transpopliteal approach. Clin Radiol 1994;49:824–827.
• Laxdal E., Jenssen G. L., Pederson G., Aune S. Subintimal angio- plasty as a treatment for femoropopliteal occlusions. Eur J Vasc Endovasc Surg, 2003, 25 : 578-582.
• Soga Y, Iida O, Suzuki K, et al. Initial and 3-year results after subintimal versus intraluminal approach for long femoropopliteal occlusion treated with a self-expandable nitinol stent. J Vasc Surg 2013;58:1547-55.
• Noory E, Rastan A, Schwarzwalder U, Sixt S, Beschorner U, et al. Retrograde transpopliteal recanalization of chronic superficial femoral artery occlusion after failed re-entry during antegrade subinti- mal angioplasty. J Endovasc Ther. 2009;16: 619–623.
• Dumantepe M. Retrograde Popliteal Access to Percutaneous Peripheral Intervention for Chronic Total Occlusion of Superficial Femoral Arteries Vasc Endovascular Surg. 2017 Jul;51(5):240-246.
• Younes HK, El-Sayed HF, Davies MG. Retrograde Transpopliteal Access Is Safe and Effective-It Should Be Added to the Vascular Surgeon's Portfolio. Ann Vasc Surg 2015; 29: 260–265.
• Shi W, Yao Y, Wang W, Yu B, Wang S, et al. Combined Antegrade Femoral Artery and Retrograde Popliteal Artery Recanalization for Chronic Occlusions of the Superficial Femoral Artery. J Vasc Interv Radiol. 2014 Sep;25(9):1363-8.
• Ye M, Zhang H, Huang X, et al. Retrograde popliteal approach for challenging occlusions of the femoral-popliteal arteries. J Vasc Surg 2013; 58:84–89.
• Komshian S, Cheng TW, Farber A, Schermerhorn ML, Kalish JA, et al. Retrograde Popliteal Access to Treat Femoropopliteal Artery Occlusive Disease J Vasc Surg. 2018 Jul;68(1):161-167.
• Ko YG. SFA Intervention: Intraluminal or Subintimal?. Korean Circ J. 2018 Aug;48(8):685-691.
• Hong SJ, Ko YG, Shin DH, et al. Outcomes of spot stenting versus long stenting after intentional subintimal approach for long chronic total occlusions of the femoropopliteal artery. JACC Cardiovasc Interv 2015;8:472-80.
• Palena LM, Diaz-Sandoval LJ, Raja LM, Morelli L, Manzi M. Precise Retrograde Supera Stenting of the Ostium (PRESTO) of the Superficial Femoral Artery for Complex Femoropopliteal Occlusions: The PRESTO Technique. J Endovasc Ther. 2018 Oct;25(5):588-591.
• Igus B, Firat A. An alternative treatment of stump occlusion of the superficial femoral artery with percutaneous direct puncture followed by antegrade recanalization. Cardiovasc Revasc Med. 2019 Nov 9; S1553-8389(19)30673-6.
• Henry M, Amicabile C, Amor M, Beron R, Henry I, Mentre B. Peripheral arterial angioplasty: value of the popliteal approach [in French]. Arch Mal Coeur Vaiss. 1993;86(4):463-469.
• Yilmaz S, Sindel T, Luleci E. Ultrasound-guided retrograde popliteal artery catheterization: experience in 174 consecutive patients. J Endovasc Ther. 2005;12(6):714-722.
• Yilmaz S, Sindel T, Erdog ̆ an A, et al. Hematoma after percutaneous transpopliteal stenting and remote suturing of the popliteal artery. J Endovasc Ther. 2002;9:703–706.
• Tokuda T, Hirano K, Muramatsu T, Tsukahara R, Nakano M. A Sheathless Retrograde Approach via the Popliteal Artery Is Useful and Safe for Treating Chronic Total Occlusions in the Superficial Femoral Artery. J Endovasc Ther. 2014 Apr;21(2):289-95