Two-Year Follow-Up After Endovascular Therapy of Superficial Femoral Arteries with Retrograde Popliteal Approach: Single-Center Experience


  • Emced Khalil Department of Cardiovascular Surgery, Ordu University Research and Education Hospital, Ordu, Turkey
  • Sedat Ozcan Department of Cardiovascular Surgery, Çanakkale 18 Mart University Faculty of Medicine, Çanakkale, Turkey



Endovascular treatment, retrograde popliteal access, superficial femoral artery, long term patenc


Objective: Popliteal artery puncture, which makes possible the use of lower profile sheaths and devices, has gained popularity as an alternative to the antegrade approach, due to the reduction in vascular complications at the access site. The present study aimed to analyze the safety of the procedure and long-term patency of the superficial femoral artery (SFA) and popliteal artery (PA) and in subjects undergoing recanalization with the popliteal retrograde approach.

Methods: Forty-three subjects, who underwent endovascular therapy (EVT) of the SFA or PA with retrograde popliteal approach, were enrolled in this retrospective study. The decision for the retrograde approach was made according to pre-intervention CT angiography results (severe calcification and relatively long CTO segment) in 20 of the subjects. The remaining 23 subjects underwent SFA or PA recanalization with the retrograde approach, due to failed antegrade recanalization attempt. All patients underwent color duplex ultrasound at the first, sixth, 12th, and 24th months to determine patency. The rate of procedural complications, including hematoma, bleeding, and distal embolism, were recorded for all subjects.

Results: Technical success was achieved in all cases. Access site complications, including hematoma and bleeding, were observed in 2 subjects (4.66%). Transfusion or surgical treatments were not required in any cases with access site complications. The acute success rate was defined as the recovery of good blood flow evaluated by angiography after EVT was 100%. Distal embolization, which did not cause any limitations in distal flow, occurred in 1 subject (2.33%). Ankle-brachial index (ABI) calculated at 1 month post-intervention was significantly higher than pre-intervention ABI [0.9 (0.59 - 1.3) versus 0.7 (0.4 - 1.1), P < .001]. Patency rates, as determined by ultrasonographic assessment at post-interventional first, sixth, 12th, and 24th months, were 100%, 95.34%, 88.37%, and 86.04%, respectively.

Conclusion: Our findings demonstrate that retrograde popliteal artery puncture can be used as a safe and effective technique for recanalization of SFA and PA stenosis and occlusions. The retrograde popliteal approach provides excellent long-term primary patency rates.


Ansari F, Pack LK, Brooks SS, Morrison TM. 2013. Design considerations for studies of the biomechanical environment of the femoropopliteal arteries. J Vasc Surg 58(3): 804-13.

Banerjee S. 2016. Superficial Femoral Artery Is Not Left Anterior Descending Artery. Circulation 134(13): 901-3.

Brountzos EN, Moulakakis KG, Avgerinos ED, Dalainas I, T GG, Kakisis J, et al. 2011. Retrograde transpopliteal approach of iliofemoral lesions. Vascular and endovascular surgery 45(7): 646-50.

Conrad MF, Cambria RP, Stone DH, Brewster DC, Kwolek CJ, Watkins MT, et al. 2006. Intermediate results of percutaneous endovascular therapy of femoropopliteal occlusive disease: a contemporary series. J Vasc Surg 44(4): 762-9.

Dumantepe M. 2017. Retrograde Popliteal Access to Percutaneous Peripheral Intervention for Chronic Total Occlusion of Superficial Femoral Arteries. Vascular and endovascular surgery 51(5): 240-46.

Goltz JP, Kleemann M. 2015. Complex recanalization techniques for complex femoro-popliteal lesions: how to optimize outcomes. J Cardiovasc Surg (Torino) 56(1): 31-41.

Heenan SD, Vinnicombe SJ, Buckenham TM, Belli AM. 1994. Percutaneous transluminal angioplasty by a retrograde subintimal transpopliteal approach. Clin Radiol 49(11): 824-7; discussion 27-8.

Henry M, Amicabile C, Amor M, Beron R, Henry I, Mentre B. 1993. [Peripheral arterial angioplasty: value of the popliteal approach. Apropos of 30 cases]. Archives des maladies du coeur et des vaisseaux 86(4): 463-9. 1993/04/01.

Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. 2006. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 113(11): e463-654.

Kawarada O. 2011. Commentary: Miniaturized retrograde popliteal approach in a supine patient. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 18(4): 510-2.

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. 2007. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 45 Suppl S: S5-67.

Saha S, Gibson M, Magee TR, Galland RB, Torrie EP. 2001. Early results of retrograde transpopliteal angioplasty of iliofemoral lesions. Cardiovasc Intervent Radiol 24(6): 378-82.

Schmidt A, Bausback Y, Piorkowski M, Werner M, Braunlich S, Ulrich M, et al. 2012. Retrograde recanalization technique for use after failed antegrade angioplasty in chronic femoral artery occlusions. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 19(1): 23-9.

Trigaux JP, Van Beers B, De Wispelaere JF. 1991. Anatomic relationship between the popliteal artery and vein: a guide to accurate angiographic puncture. AJR Am J Roentgenol 157(6): 1259-62.

Ueshima D, Ashikaga T, Shimura T, Hatano Y, Sasaoka T, Kurihara K, et al. 2015. Popliteal Retrograde Approach is Effective and Safe for Superficial Femoral Artery Chronic Total Occlusion. Ann Vasc Dis 8(3): 220-6.

Wojtasik-Bakalarz J, Arif S, Chyrchel M, Rakowski T, Bartus K, Dudek D, et al. 2017. Twelve months follow-up after retrograde recanalization of superficial femoral artery chronic total occlusion. Postepy Kardiol Interwencyjnej 13(1): 47-52.

Yahagi K, Otsuka F, Sakakura K, Sanchez OD, Kutys R, Ladich E, et al. 2014. Pathophysiology of superficial femoral artery in-stent restenosis. J Cardiovasc Surg (Torino) 55(3): 307-23.

Ye M, Zhang H, Huang X, Shi Y, Yao Q, Zhang L, et al. 2013. Retrograde popliteal approach for challenging occlusions of the femoral-popliteal arteries. J Vasc Surg 58(1): 84-9.

Yilmaz S, Sindel T, Luleci E. 2005. Ultrasound-guided retrograde popliteal artery catheterization: experience in 174 consecutive patients. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 12(6): 714-22.

Zaitoun R, Iyer SS, Lewin RF, Dorros G. 1990. Percutaneous popliteal approach for angioplasty of superficial femoral artery occlusions. Catheterization and cardiovascular diagnosis 21(3): 154-8.



How to Cite

khalil, emced, & çzcan, sedat. (2020). Two-Year Follow-Up After Endovascular Therapy of Superficial Femoral Arteries with Retrograde Popliteal Approach: Single-Center Experience. The Heart Surgery Forum, 23(3), E295-E299.