Kronik Yüzeyel Femoral Arter Tıkanıklığında Retrograd Rekanalizasyon: Birincil Strateji Olarak Güvenli ve Etkili mi?

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%; p0.05) .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