Journal of Vascular and Endovascular Therapy

Evaluation of Femoro-Popliteal Angioplasties with the Need for Retrograde Approach in a Twin Center Series of 26 Consecutive Cases

Objectives: To evaluate the feasibility of percutaneous angioplasty using the Sub-intimal Arterial Flossing with Anterograde-Retrograde Intervention (SAFARI) technique in case of femoro-popliteal occlusion.

Methods: This twin centers study included, from November 2012 till April 2015, all the attempts to carry out a femoro-popliteal angioplasty by SAFARI technique after anterograde failure.

Results: Twenty-six patients were included (10 [38.5%] diabetics, mean age 67 ± 12 years). Twelve (46.2%) suffered from claudication and 14 (53.8%) from Critical Limb Ischemia (CLI). Mean lesion length was 175.8 ± 100.3 mm, with 4 (15.4%) Trans-Atlantic Society Consensus (TASC) C and 18 TASC D lesions (69.2%). Technical success was 84.6% (22 patients, 20 [76.9%] popliteal punctures), including 3 (11.5%) “rendezvous” techniques. Mean number of stents/patient was 1.5 ± 1.1 (diameter of 6.1 ± 0.3 mm, 196.0 ± 116.1 mm long) with systematic predilation (4.5 ± 1.1 mm in diameter, 116.8 ± 38.3 mm long balloons). Thirteen patients (50.0%) underwent simultaneous additional procedures. One hematoma (4.2%) occurred at the distal puncture site, without the need for surgery. Mean follow-up was 19.5 ± 12.4 months with a patency rate of 90.0% at 6 months and 50.8% at 12, 24 and 36 months, without redo surgery on target arteries in 100.0% of the cases at 6 months and 84.4% at 12, 24 and 36 months. At latest follow-up, 3 patients suffered from claudication (15.0%) and 6 were in CLI (30.0%). Four of 12 CLI patients were completely healed (33.3%) and 17 (85.0%) were clinically improved. Limb salvage rate was 96.2%. Estimated overall survival rate is 95.7% at 6 months, 90.6% at 12 months, 67.1% at 24 months and 40.3% at 36 months.

Conclusion: The SAFARI technique is a minimally invasive approach increasing per-operative technical success of femoro-popliteal percutaneous angioplasties, without increasing the rate of local complications or influencing patency in the short-run.

Author(s):

Morin Julien, Lakhlifi Emilie, Midy Dominique, Poirier Mathieu, Caradu Caroline and Ducasse Eric

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