Primary retrograde transpedal approach for revascularization of chronic total occlusions of the superficial femoral artery and re-route technique using percutaneous puncture for re-entry.

Purpose: We aimed to demonstrate the safety and feasibility of revascularization of chronic total occlusion of the superficial femoral artery (SFA) using the transpedal approach and describe a new technique called "re-route".

Methods: The study included all consecutive patients who had chronic total occlusions at the level of SFA and underwent retrograde treatment through a pedal artery intervention between September 2017 and October 2019. Balloon angioplasty was applied as the first treatment option. After angioplasty, bailout stenting was performed when necessary in patients with indications. If the common femoral artery lumen could not be reached from the SFA ostium, the re-route technique was used. Technical success was defined as revascularization with residual stenosis of less than 30%.

Results: Twenty-five SFAs were revascularized in 23 patients (17 males; mean age, 66±7.3 years) by angioplasty in 5 SFAs and angioplasty and stents in 20 SFAs. While the transpedal approach was applied after the failure of antegrade recanalization in three patients, it was used as the first treatment route in the remaining cases. The re-route technique was applied in 7 patients, with a 100% technical success rate. The mean follow-up was 15.3 months (range, 12-18 months). The primary patency rate was 78% at one year.

Conclusion: The retrograde transpedal approach is a safe and successful technique for chronic total occlusion recanalization and carries a low risk of complications. In order to increase technical success, the re-route technique can be used as an alternative re-entry method.