Conversion of Antegrade to Retrograde Access for Endovascular Superficial Femoral Artery Interventions Using a Failed Previously Performed Femoropopliteal Bypass Graft as a Conduit

Endovascular therapy is a common approach for superficial femoral artery (SFA) symptomatic disease, commonly accessing the contralateral femoral artery, crossing the aortic bifurcation. Occasionally, antegrade recanalization is not feasible secondary to causes such as ostial SFA occlusion, wire perforation or inability to obtain distal re-entry. The authors report a 66-year-old woman with lifestyle-limiting claudication caused by aortoiliac and SFA atherosclerosis, who was previously treated with an iliac stent and a femoropopliteal bypass prosthetic graft. When her prosthetic graft occluded about one year after its construction, an antegrade approach to the SFA via retrograde puncture to the contralateral femoral artery was used for revascularization. After initial attempts to recanalize the occluded SFA, they used the prosthetic graft as a conduit to enter the occluded artery distally, eventually converting the retrograde access into antegrade. To the best of our knowledge, this is the first report in the use of this technique. Using a failed femoropopliteal bypass as a conduit to access the SFA in a retrograde manner can be safely and effectively performed especially in flush occlusions when there is no SFA proximal stump for recanalization.