Popliteal access for iliofemoral occlusive disease in the office-based catheter laboratory

Selected in Journal of Vascular Surgery by Xavier Devoisin

This retrospective single-center study evaluates the safety and efficacy of popliteal access for endovascular treatment of iliofemoral occlusive disease in an outpatient setting. Among 27 procedures, revascularisation was successful in 92.5 % of cases, with no major adverse events and a low reintervention rate at 3 and 12 months. The findings support popliteal access as a safe and effective alternative for complex iliofemoral disease in outpatient care.

References:

Authors: Hani Shennib, Emily Teribery, Amanda Evans, and Victor Huerta

Reference: J Vasc Sur. 2025 Jan;81(1):165-171. doi: 10.1016/j.jvs.2024.08.055. Epub 2024 Aug 30.

DOI: DOI: 10.1016/j.jvs.2024.08.055

Read the abstract

Objective:

To evaluate the safety and efficacy of popliteal access for endovascular treatment of iliofemoral occlusive arterial disease in an outpatient setting.

Study:

Single-center retrospective cohort

Outcomes and conclusion:

27 procedures using popliteal access for femoral and iliac artery occlusions. Revascularisation success in 92.5 % of cases.
No major adverse events observed, with no reintervention at 3 months in 95 % of cases and at 12 months in 79 % of cases.

Popliteal access for complex iliofemoral disease is safe and effective and should be considered a viable alternative in outpatient care.

Figure 3: Popliteal access for iliofemoral occlusive disease in the office-based catheter laboratory

Source: Journal of Vascular Surgery

Figure 4: Popliteal access for iliofemoral occlusive disease in the office-based catheter laboratory

Source: Journal of Vascular Surgery

Comments:

Disadvantages:

Operator concerns regarding popliteal access: risk of hematomas, bleeding complications, and nerve injuries.
Concerns about patient discomfort and complications associated with the prone position.

Advantages:

Easy puncture of the popliteal artery.
Close proximity to target lesions allows for better device manipulation.
Low complication rate and quick recovery time.
Facilitates ventilation in COPD patients.
Suitable for obese patients, as fat is primarily located medially to the knee.
Excellent and precise localized manual compression.

Clinical insights:

89% of patients were Rutherford 4 or 5, a significantly higher proportion than in other studies using tibial approaches.
Challenges the preference for open surgery in TASC C lesions.
In this study, 70% of cases were TASC D, typically associated with high comorbidity and surgical risk.
Endovascular treatment should be considered a viable alternative to avoid the risks of open surgery.
First-line approach for patients with prior stents or endografts for aneurysms or aortoiliac occlusions, or those with hostile Scarpa’s triangles.
Ultrasound-guided puncture minimizes complication risk.

Procedure efficiency:

Short operative times: 58 minutes on average.
Lower contrast agent usage: 46 ml.
Reduced fluoroscopy time: 17 minutes, 20 seconds.
Lower radiation dose: 64.1 mGy.