Antegrade popliteal artery approach for the treatment of critical limb ischemia in patients with occluded superficial femoral arteries

Treating patients with critical limb ischemia (CLI) secondary to superficial femoral artery (SFA) occlusions and jeopardized tibial-peroneal run-off is challenging, especially when the SFA cannot be recanalized. These patients are frequently poor candidates for surgical revascularization and thus amputation is the therapy most often recommended. In this article, we describe a new technique for treating these patients, which combines antegrade popliteal arterial access with tibial arterial revascularization using drug eluting stents (DES). Five patients scheduled for below-knee amputations were successfully treated using this endovascular approach. For the duration of follow-up (29 +/- 8 months), all patients remained free of death, amputation, or target lesion revascularization. ABI's post intervention demonstrated a modest improvement (ABI = 0.32 +/- 0.09 vs. 0.58 +/- 0.09 pre vs. post, P < 0.01). Technical details and rationale for this approach are discussed. Thus, in a well defined subset of patients with recent onset CLI and SFA occlusion, antegrade popliteal DES supported angioplasty offers additional options for patients who might otherwise face amputation. (C) 2007 Wiley-Liss, Inc.