Evaluation of Retrograde Tibiopopliteal Access in Failed Femoral Access for Chronic Femoral Artery Occlusion

Background: The retrograde contralateral ("crossover"), antegrade ipsilateral, or retrograde tibiopopliteal ("facedown") methods may be used to treat superficial femoral artery occlusions. The retrograde strategy originally had several drawbacks but served as a fallback. Objective: To evaluate the results (efficacy, patency, limb salvage rate, improvement of clinical outcome and complications) of revascularization in total femoral arterial occlusive disease using retrograde distal (tibiopopliteal) access in failed femoral access. Patients and methods: This prospective cohort research was conducted in Al-Azhar University Hospitals (Al-Hussain and Bab-Alsheryah) between January 2019 and October 2022 on 31 patients with a SFA Lesions can’t be treated from femoral approach. Results: The most frequent clinical finding was severe claudication (61.29%). All patients received local anasethia. Most patients were treated by balloon angioplasty (71%) and (29%) need SFA stenting. High rate of Technical Success was observed (92.86%) with popliteal access and (100%) with tibial access. ABI showed marked improvement after procedure from 0.35 to 0.87. low rates of peri-procedural complications occurred in (16.1%) of patients which are mainly hematomas at puncture sites in (12.9%) of patients. Significant improvement in ABI in follow up visits as 0.78 at 3-months visit and 0.75 at 12-months visit with major amputation in only (9.7%) at 3-months visit and (19.35%) at 12-months visit. Conclusion: When femoral access is restricted, the retrograde popliteal artery approach with duplex guiding might be thought of as a safe, effective, and practical access for SFA occlusions.