Author + information
- Kenji Yanishi1,
- Kan Zen1,
- Osami Kawarada2,
- Naohiko Nakanishi1,
- Takeshi Nakamura1 and
- Satoaki Matoba1
Trans popliteal retrograde approach is often used simultaneously in the endovascular therapy (EVT) for the femoropopliteal chronic occlusive diseases (CTOs) and puncturing popliteal artery in a supine position is supposed to be reasonable. Although that kind of procedure has potential concerns about hemostasis like arteriovenous (AV) fistula or hematoma, their frequencies and severities have not been known in detail.
This registry was a prospective, multicenter study. A total of 47 patients (35 men; mean age 76 years) were enrolled. They underwent an EVT for femoropopliteal CTO using a trans popliteal retrograde approach with angiographic guidance in the supine position. A small-size sheath of three or four French (Fr) in diameter was inserted into the popliteal artery in all patients, and hemostasis was conducted with a manual compression device just after completion of the procedure. The hemostatic complications were defined as; AV fistula, hematoma requiring a blood transfusion, and pseudo aneurysm. The puncture site of the popliteal artery was estimated by duplex ultrasound on Days 1, 30, and 180 after the EVT. The primary outcome was the incidence of hemostatic complications and secondary outcomes were procedure success and procedure-related limb amputation.
The trans popliteal retrograde approach with angiographic guidance in the supine position was conducted successfully in all cases, with an average puncture time of 3.2 minutes. A 3-Fr or 4-Fr sheath was inserted into the popliteal artery in 31 (66%) and 16 (34%) cases, respectively. All sheath procedures were completed successfully, with an average total procedure time of 135 minutes. There were hemostatic complications of the popliteal artery in 8 (17%) cases, whereas 7 (15%) cases had AV fistula, and 1 (2%) case had hematoma requiring the blood transfusion. For 5 cases, the AV fistula naturally resolved without clinical symptoms 30 days after the procedure. For 1 case, the AV fistula resolved without clinical symptoms 9 months after the procedure. The last case resulted in sudden death 30 days after the procedure, with no vascular event in the leg. Many cases of AV fistula resolved without clinical symptoms, and with no vascular event of the leg.
Although AV fistula was frequently observed, it resolved without additional hemostatic treatment. Therefore, the retrograde trans popliteal approach with an angiography-guided puncture in the supine position is a useful method that complements the antegrade approach and can be converted easily during EVT for femoropopliteal CTOs.