Retrograde transpopliteal access in the supine patient for recanalization of the superficial femoral artery after failed antegrade angioplasty

Background: The prevalence of peripheral arterial disease is increasing worldwide due to the increase in life expectancy, obesity, and diabetes. Symptomatic atherosclerosis of the lower extremity arteries commonly involves the superficial femoral artery ( SFA) and is characterized by long, diffuse lesions and long total occlusions. Patients and methods: All patients underwent percutaneous recanalization from a retrograde popliteal access after failure to pass through the antegrade access either by the ipsilateral or by the contralateral femoral approach. All patients were symptomatic with ipsilateral disabling intermittent claudication. Results: Technical success, defined as puncture of the popliteal artery and recanalization of the SFA, was achieved in all cases. The mean ankle–brachial index increased from 0.5 ± 0.2 preoperatively to 0.7 ± 0.1, with improvement in the walking distance. Primary patency was 80.7% at 6 months and 76.9% at 1 year. Conclusion: Percutaneous recanalization of femoropopliteal TASC C and D lesions can be increased by the transpopliteal approach. The retrograde popliteal approach with the patient in the supine position can be considered a ‘first-choice’ method for safe and effective SFA recanalization, especially in occlusions located at the distal and the mid portion SFA and that failed to pass through the femoral antegrade approach. It is an inexpensive and easy-to-learn technique.