Subintimal recanalization of long superficial femoral artery occlusions through the retrograde popliteal approach

Purpose: To investigate the value of the retrograde popliteal artery approa ch for the percutaneous intentional extraluminal recanalization (PIER) of l ong superficial femoral artery (SFA) occlusions. Methods: During a period of 17 months, PIER through ultrasound-guided retro grade popliteal artery puncture was performed for 39 long SFA occlusions in 37 patients. In six patients, six additional iliac artery stenoses were al so treated via the popliteal approach. Results: The procedure was technically successful in 32 (82%) of 39 SFA occ lusions: in 29, lesions were treated with balloon angioplasty alone, and in three, stents were also used. Cumulative patency rate was 66% at 6 months, 62% at I year, and 59% at 18 months. Additional iliac artery stenoses were successfully treated in the same session. Complications included two minor hematomas and two SFA ruptures, which required no treatment. Conclusion: PIER through retrograde popliteal puncture is a safe and effect ive method in the treatment of long femoro-popliteal occlusions, with a hig h technical success, low complication rate and a reasonable short-term pate ncy rate. The technique offers an alternative in cases where standard PIER is unsuccessful or contraindicated.