[MP-10] A case of popliteal artery perforation by retrograde approach using micro catheter
without a sheath
Bidirectional approach has been reported to improve the initial success rate of endovascular treatment for superficial femoral arterial chronic total occlusion (SFA CTO). However, popliteal arterial injury is generally concerned by sheath insertion. To minimize the vascular injury, we have used 18G surflo and micro catheter for popliteal cannulation without a sheath.
This case was a 67-year-old female with hemodialysis. She suffered from right intermittent claudication (FontaineⅡB, Rutherford3). Angiography showed SFA CTO (TASCⅡ D). First, we started crossover approach using 6Fr guide sheath from left femoral artery, but didn’t cross the lesion by antegrade approach. We switched to retrograde approach. We used plastic cannula system consisting of 18G surflo cannula. Through the plastic cannula inserted into the popliteal artery, the guide wire within the micro catheter was retrogradely crossed through SFA CTO. However, popliteal artery perforation was occurred due to the reversal of the micro catheter in below knee area. This reason is because we pushed the micro catheter strongly for severe calcification. We performed balloon inflation for 10 minutes with compression device (TOMETAKUN) in the perforation site. It was obtained hemostasis. Fortunately, it didn’t lead to compartment syndrome.
We experienced a case of popliteal artery perforation by retrograde approach using micro catheter without a sheath. It is necessary to pay attention to the position of the micro catheter if retrograde approach was performed.
This case was a 67-year-old female with hemodialysis. She suffered from right intermittent claudication (FontaineⅡB, Rutherford3). Angiography showed SFA CTO (TASCⅡ D). First, we started crossover approach using 6Fr guide sheath from left femoral artery, but didn’t cross the lesion by antegrade approach. We switched to retrograde approach. We used plastic cannula system consisting of 18G surflo cannula. Through the plastic cannula inserted into the popliteal artery, the guide wire within the micro catheter was retrogradely crossed through SFA CTO. However, popliteal artery perforation was occurred due to the reversal of the micro catheter in below knee area. This reason is because we pushed the micro catheter strongly for severe calcification. We performed balloon inflation for 10 minutes with compression device (TOMETAKUN) in the perforation site. It was obtained hemostasis. Fortunately, it didn’t lead to compartment syndrome.
We experienced a case of popliteal artery perforation by retrograde approach using micro catheter without a sheath. It is necessary to pay attention to the position of the micro catheter if retrograde approach was performed.