Retrograde approach for endovascular revascularization

Abstract

Introduction: Conventional antegrade vascular access for endovascular revascularization of ostial superficial femoral (SFA) or iliac arteries (IA) has a failure rate of up to 20% and requires special delivery and recanalisation devices. Thus the retrograde approach is necessary. Aim of the study: To analyze own experience of safety and efficacy of ultrasound-guided retrograde popliteal and femoral access in patients with atherosclerotic lesions. Material and methods: We retrospectively analyzed results of endovascular treatment of 32 patients with superficial femoral (SFA) or iliac arteries during the 2018-2019 years, whom retrograde approach was applied. Results: 32 patient with SFA (12 patients) and IA occlusion (20 patients) underwent 16 popliteal access and 16 common femoral artery access. Arterial punctures were performed under ultrasound guidance. 6F introducer was used 26 times, 5F – 4 and 8F – 2 times respectively. Twice we used Straub Rotarex system. Revascularization was done by balloon angioplasty or stenting. Technical success of the procedure was achieved in all cases. Hemostasis was achieved by manual compression and subsequent 24-hour duration bandaging without closure devices. Radiation dose was lower and fewer devices usage was noted compared to the antegrade approach. There were no major complications. There was one incidence of calf vein thrombosis and two puncture site hematoma. Conclusion: Ultrasound-guided retrograde popliteal and common femoral approach can be considered safe and highly effective for endovascular revascularization.