Marcello Chiocchi, Abstract Co-Author: Nothing to Disclose

Luciano Maresca MD, Presenter: Nothing to Disclose

Massimiliano Di Primio MD, Abstract Co-Author: Nothing to Disclose

Daniel Konda, Abstract Co-Author: Nothing to Disclose

Giovanni Simonetti MD, Abstract Co-Author: Nothing to Disclose

Roberto Gandini MD, Abstract Co-Author: Nothing to Disclose

To propose our technique, to obtain the optimal recanalization to the foot in case of long SFA occlusions involving the popliteal trifurcation, using a combined antegrade and retrograde subintimal approach in patients presenting critical limb ischemia (CLI).

On 664 diabetic Patients treated for limb salvage, in 47 with SFA long occlusions involving the leg vessel tree, were performed subintimal antegrade and retrograde (posterior tibial artery in 27 and anterior tibial artery in 20 cases) approach. The patent portion of the runoff vessel was previously assessed by magnetic resonance angiography and directly punctured under ultrasound Doppler guidance. A subintimal channel rendezvous was performed to allow snaring of the guidewires. Subsequent balloon dilatation was performed.

We achieved 97.5% technical success. At Doppler-US mean follow up of 13.5 months, the patent vessels was 69.5%, but we had a 91.4% in limb salvage with complete healing of limb lesions and rest pain resolution . The oximetry value showed an increase from mean original value of 17.3 mmHg to 44.3 mmHg at 6 months follow-up.

In patients with SFA occlusion involving the popliteal trifurcation, secure candidate in amputation, combined antegrade and retrograde subintimal recanalization approach, is probably the most suitable and efficacy endovascular option to obtain a direct flow to the foot and so, an high percentage of limb salvage.

combined antegrade and retrograde subintimal recanalization approach, is probably the most suitable and efficacy endovascular option to obtain an high percentage of limb salvage.

Chiocchi, M, Maresca, L, Di Primio, M, Konda, D, Simonetti, G, Gandini, R, Transfemoral and Transtibial Combined Approach in Subintimal Recanalization of SFA Obstructions Extending on Popliteal and Distal Vessels Origin.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6014951.html