Ultrasound-assisted sagittal view for retrograde puncture of the P2 segment of popliteal artery for recanalization of femoropopliteal lesions.

ABSTRACT

OBJECTIVES: To assess the safety and efficacy of ultrasound-assisted sagittal view for retrograde puncture of the P2 segment of popliteal artery(PA) for treating femoropopliteal lesions. METHODS: A retrospective study was conducted on consecutive patients who underwent retrograde puncture of the popliteal artery (PA) for the recanalization of femoropopliteal lesions. A retrograde access was made to either the P2 or P3 segment of the PA in 23 cases. In 10 cases (8 men; mean age 68±9 years), ultrasound-guided retrograde PA (P2 segment) puncture using the long-axis in-the-plane approach was performed, and in 13 cases (11 men; mean age 69±5 years), angiography-guided retrograde PA (P3 segment) puncture was performed. Clinical data was compared pre-intra-operatively and post-operatively in the two groups. RESULTS: All occluded lesions were successfully recanalized via dual channel intervention. Puncture success were 100%(10/10) in the P2 group compared with 92.3%(12/13) in the P3 group (p>0.05). The mean puncture time in the P2 group was significantly shorter when compared to the P3 group (4.70±0.95 mins vs 11.33±6.37mins; p< 0.05). There was no difference in mean hemostasis time between the two groups (6.11±2.20 mins vs 8.46±3.76mins; p>0.05). There were no in-hospital deaths in all patients. The occurrence of puncture-related complications in the P2 group was 10% compared with 15% in the P3 group (p>0.05). A low-flow AVF was observed in one case in the P3 group. None of the patients reported any access-related complication at a mean follow-up of 11.3±5.5months. CONCLUSIONS: Ultrasound-assisted sagittal view for retrograde puncture of the P2 segment of PA is at least as safe as angiography-guided retrograde puncture of the P3 segment for femoropopliteal lesions. Furthermore, this technique appears to be more suitable for patients with tandem iliofemoral artery occlusion, as it allows for the creation of a retrograde access.