The Safety and Feasibility of Retrograde Popliteal Approach Using Plastic Cannula for Endovascular Treatment of Superficial Femoral Arterial Chronic Total Occlusion

Abstract

Background: Bidirectional approach using popliteal method has been reported to improve the initial success rate of endovascular treatment (EVT) of superficial femoral arterial chronic total occlusion (SFA CTO). However, popliteal arterial injury is concerned by sheath insertion. To minimize the vascular injury, we have used plastic cannula by echoguidance alternative to sheath for popliteal cannulation. The purpose of this study was to investigate the safety and feasibility of retrograde popliteal approach using plastic cannula in EVT of SFA CTO. Methods: We used plastic cannula system consisting of Teflon cannula with the outer diameter of 1.3mm and the length of 150 mm, and 20 G needle. Through the plastic cannula inserted into the popliteal artery, the guidewire within the microcatheter was retrogradely crossed through SFA CTO and was pulled through 6Fr femoral sheath. Ballooning and stenting were performed from the femoral sheath. We retrospectively investigated the safety and feasibility of this technique according to the initial success, popliteal arterial injury. Results: The initial success was obtained in 21 of the 23 SFA CTO treated with this technique although the averaged CTO length was 18.1 cm. No major popliteal injury or hematoma was observed by sonography. Conclusion: Retrograde popliteal approach using plastic cannula was feasible and a less invasive technique for EVT of SFA CTO.