Alternative Subintimal Recanalization Technique Using Fluoroscopy-Guided Direct Puncture at the Level of the Common Femoral Artery

Abstract

Leonardo Da Cruz Reno, Luis Eduardo Fogaca Ribeiro and Angelica Araujo Cortines Laxe Reno

Objective: To present a clinical case of subintimal angioplasty of the popliteal femoral territory using an alternative technique of re-entry into the lumen after failure with traditional re-entry methods.

Material and Methods: This case involves a patient with a history of infrapopliteal femoro-popliteal bypass with a previous inverted internal saphenous vein by-pass (2021), admitted for angioplasty to maintain primary patency assisted by a stenosis in it, but showing total occlusion of the by-pass during intraoperative arteriography. Due to the intense symptoms, whi risk of limb loss, endovascular femoral recanalization was performed, without success in performing intraluminal recanalization by anterograde and retrograde routes. Subintimal recanalization was performed, using an alternative salvage technique to allow re-entry into the true lumen, described in this article.

Results: Retrograde subintimal recanalization was performed with intraluminal re-entry into the proximal superficial femoral artery via fluoroscopy-guided puncture in an intraluminal balloon implanted in a retrograde direction, with implantation of 3 stents. No residual femoropopliteal stenosis was observed, with good inflow and outflow.

Conclusion: The subintimal recanalization technique in itself is already a salvage technique, and with the aid of fluoroscopy-guided intraluminal balloon puncture by distal retrograde puncture, we were able to break through the dissection flap and re-enter the lumen proximally, enabling dilation and implantation of subintimal stents with technical success.

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