Novel technique to tackle flush superficial femoral artery chronic total occlusion | ||
| The Egyptian Journal of Surgery | ||
| Article 4, Volume 40, Issue 3, July 2021 PDF (542.11 K) | ||
| DOI: 10.4103/ejs.ejs_71_21 | ||
| Authors | ||
| Naga R. Ahmad; Badra Ali; El Mahdi Ahmed | ||
| Abstract | ||
| Context Flush superficial femoral artery (SFA) occlusions often show hard, rounded, and eccentric plaque that pushes the guide-wire to go preferentially into the profunda femoral artery whenever a trial of angioplasty is carried out. Aims In this work, we evaluated a new bail-out technique to facilitate cannulation of flush SFA occlusion; we refer to it as ‘profunda occluding balloon’ technique. Settings and design This was a retrospective study that included patients with peripheral arterial disease admitted to the ward of Vascular Surgery Unit at Alexandria University Hospital between August 2019 and December 2020. All patients had chronic peripheral arterial disease Fontaine classification (IIb–IV). Multislice Computed Tomographic Angiography showed TASC II A/B/C femoropopliteal lesions with flush SFA occlusions. All cases had patent aortoiliac segment with good distal popliteal run off. Patients with acute leg ischemia or extensive foot necrosis necessitating amputation were excluded from the study. Patients and methods The new technique entails inflating a balloon in the profunda femoral artery in a fashion to create an ostium for the SFA. Then, a wire is forced into the SFA and the procedure continues as usual, tailored according to the lesion pattern. Results A total of 46 cases with flush SFA occlusions were included in the study. The traditional methods for SFA cannulation succeeded to cannulate the artery in 34 cases. Therefore, the new ‘profunda occluding balloon’ technique was tried in the other 12 cases. In 10 of them, the SFA was successfully cannulated; the technical success rate was 83%. For the remaining two patients who had technical failure, bypass surgery was resorted to. Among the 10 patients whom the new technique was used for, the guide-wire passed subintimally in eight of them with spontaneous re-entry at the popliteal run-off site, and in two patients, the guide wire was passed intraluminally. Conclusions This ‘profunda occluding balloon’ technique was shown to be a cheap maneuver with a high technical success rate for cannulating flush SFA occlusions. We encourage interventionists to use it as a bailout method in case other traditional approaches fail. | ||
| Keywords | ||
| Chronic total occlusion; flush superficial femoral artery occlusion; profunda femoral artery; profunda occluding balloon technique | ||
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