1. Anatomical Considerations of Infrageniculate Popliteal Artery Puncture: Alternative Pathway for Retrograde Access After Failed Re-entry
- Author
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Patrick Lermusiaux, Antoine Millon, Arthur Normand, Philippe Tresson, Nellie Della Schiava, Thibaut Mennecart, CCSD, Accord Elsevier, Service de Santé des Armées, Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)
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Patient-Specific Modeling ,medicine.medical_specialty ,Popliteal Vein ,Computed Tomography Angiography ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Punctures ,030204 cardiovascular system & hematology ,Revascularization ,030218 nuclear medicine & medical imaging ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Peripheral Nerve Injuries ,Predictive Value of Tests ,Cadaver ,medicine.artery ,Popliteal vein ,Catheterization, Peripheral ,medicine ,Humans ,Popliteal Artery ,Muscle, Skeletal ,Tibial nerve ,Retrospective Studies ,Computed tomography angiography ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,General Medicine ,Vascular System Injuries ,Popliteal artery ,[SDV] Life Sciences [q-bio] ,Angiography ,Feasibility Studies ,Surgery ,Radiology ,Tibial Nerve ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
International audience; BACKGROUND: A distal approach in endovascular procedures for revascularization of lowers limbs can be considered in case of no re-entry in subintimal recanalization. The aim of this study is to evaluate the feasibility of a medial approach to the infrageniculate popliteal artery (IPA) using existing computed tomography (CT) scan simulation and punctures performed on cadavers. METHODS AND RESULTS: CT angiographies of lower extremities were used to simulate IPA puncture and puncture trajectory. Tissues damaged during the trajectory between the puncture site and the access-related injuries were analyzed. Anatomical punctures on cadaverous model were also performed. Corpses were placed in supine position, the hip in slight flexion (40°) and abduction (external rotation of 60°). A 16 G needle was used for the IPA puncture. Twelve CT angiography simulations were made. Of these 12 simulations, 9 revealed an isolated lesion of the popliteal vein and 2 isolated lesions of the tibial nerve. A lesion of the tibial nerve and the popliteal vein on the same simulation was once observed. Damage to the medial gastrocnemius muscle could not be avoided in each case. Ten punctures were performed on cadavers with technical success. There were 6 popliteal vein lesions, 3 tibial nerve lesions, and 1 case without lesion. In all cases, damage to the medial gastrocnemius muscle was seen. CONCLUSIONS: This medial approach was feasible and is accompanied by trauma of elements of the popliteal pedicle. Preoperative CT angiography could anticipate best site of puncture and potential access-related injury.
- Published
- 2020
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