Novel distal popliteal artery puncture technique in supine position for chronic femoropopliteal arterial occlusion; frontal popliteal puncture Miyazaki Medical Association Hospital Cardiovascular Center Department of Cardiology Kenji Ogata, MD. Tatsuya Nakama, MD. Tatsuro Takei, MD. Yoshisato Shibata, MD.
Disclosure Speaker name: Kenji Ogata... I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
Retrograde Popliteal access is a good option for recanalization of SFA CTO The retrograde proximal popliteal approach with the patient in the supine position is useful technique. Kawarada O, et al : J Endovasc Ther 17 : 255-258,2010. Fanelli F, et al : J Endovasc Ther 18 : 503-509, 2011.
Frontal popliteal (P3 segment) puncture P 1 P 2 P3 segment was existed at behind the tibial bone head
Case review: 80 s CLI (R5) CLI (Rutherford 5) small ulceration in his right 4 th toe Type 2 DM HbA1c: 8.4 % ABI Right : 0.61 Left : 0.87 SPP Rt. Dorsal 12mmHg Rt. Plantar 26mmHg
Ipsilateral oblique view Maximum separation position of tibial and fibular bone
Contralateral oblique view Check the puncture needle depth
Sheathless technique is necessary Low-profiled microcatheter (1.8Fr)
Final angiogram It disclosed satisfactory result!!
Consecutive cases of distal SFA puncture Retrograde approach for SFA-CTO 78 patients (89 lesions) 63 patients (74 lesions ) excluded Popliteal artery puncture Distal SFA direct puncture Trans-collateral approach Below-the-knee artery puncture Frontal popliteal puncture was performed for SFA-CTO lesions 15 patients (15 lesions)
Patients Characteristics Patients characteristics n= 15 Age 74.6 ± 9.2 Male n, (%) 13 (86.7) Non-ambulatory status, n (%) 2 (13.3) Hypertension, n (%) 13 (86.7) Dyslipidemia, n (%) 3 (20.0) Diabetes mellitus/ insulin user, n (%) 6 (40.0) Insulin user, n (%) 2 (13.3) Smoking history, n (%) 9 (60.0) Daily hemodialysis, n, (%) 1 (6.7) egfr, ml/min/1.73m 2 66.8 ± 22.6 History of coronary artery disease, n (%) 6 (40.0) History of cerebrovascular disease, n (%) 4 (26.7) Medication, n(%) Aspirin/ Cropidgrel/ Cilostazol/ Anticoagrant 7(46.7)/ 11(73.3)/ 11(73.3)/ 4(26.7) Continuous data are presented as the means ± standard deviation, categorical data are given as the counts(percentage). egfr: estimated glemerular filtration rate (ml /min/1.73m2)
Puncture procedure Target limbs status n= 15 Critical limbs ischemia 9 (60) Ankle brachial pressure index (ABI) Pre ABI 0.47 ± 0.30 Post ABI 0.89 ± 0.16 Lesion Backgrounds and Procedure n=15 TASC II classification, A/B/C/D, n (%) 0(0)/ 0(0)/ 2(13.3)/ 13(86.7) Lesion length, mm 254.9 ± 57.2 Target vessel reference, mm 5.9 ± 0.9 De novo lesion, n (%) 13 (86.7) Moderate to severe calcification 5 (33.3) Crossover antegrade approach, n (%) 15 (100) Reason of antegrade failure, n (%) Flash CTO/ Perforation/ stuck/ reentry failure 3(20)/ 1(6.7)/ 1(6.7)/ 10(66.7) Success of frontal popliteal puncture, n (%) 15 (100) Guidewire crossing technique, n (%) reverse CART/ Wire rendezvous 4(26.7)/ 11(73.3) Continuous data are presented as the means ± standard deviation, categorical data are given as the counts (percentage).
Puncture procedure Retrograde procedure n= 15 Balloon assisted hemostasis, n (%) 15 (100) balloon size, mm 3.93 ± 0.46 hemostatic time, min 13.3 ± 4.3 Puncture site complication Overall procedural related complication, n (%) 1 (6.7) Re-bleeding during procedure, n (%) 1 (6.7) 30-days access site complication, n (%) 0 (0) 30-days adverse event, n (%) 0 (0) Continuous data are presented as the means ± standard deviation, categorical data are given as the counts(percentage).
Summary of procedure In 15 consecutive case of frontal popliteal puncture Puncture success rate: 100% Procedural success rate: 100% Puncture related complication rate: 6.7% (1 case)
Conclusion Retrograde distal popliteal artery (P3 segment) puncture in supine position; frontal popliteal puncture technique might be feasible and safe option for femoropopliteal chronic occlusion.
Thank you for your attention! Kenji Ogata.MD Department of Cardiology, Miyazaki Medical Association Hospital Miyazaki, Japan
Novel distal popliteal artery puncture technique in supine position for chronic femoropopliteal arterial occlusion; frontal popliteal puncture Miyazaki Medical Association Hospital Cardiovascular Center Department of Cardiology Kenji Ogata, MD. Tatsuya Nakama, MD. Tatsuro Takei, MD. Yoshisato Shibata, MD.