Retrograde Approach for Contralateral Iliac and Infrainguinal Percutaneous Transluminal Angioplasty: Experience in 100 Patients

To assess the technical feasibility of percutaneous transluminal angioplasty (PTA) performed by means of a retrograde contralateral approach, 201 PTA procedures performed from January 1989 to August 1990 were retrospectively reviewed. In 100 of these cases, the retrograde femoral artery puncture employed for acquisition of the initial diagnostic arteriogram was also used for angioplasty of 173 contralateral arteries. The overall technical success rate for PTA via the contralateral route was 91% (157 of 173 arteries). Overall success for contralateral suprainguinal disease was 94% (61 of 65) and was as follows for infrainguinal disease: femoral, 88% (68 of 77); popliteal, 90% (18 of 20); graft anastomoses, 100% (five of five); and infrapopliteal, 83% (five of six). There were eight procedure-related complications, including one clinically insignificant distal atheroembolization, two sheared balloon fragments, three arterial thromboses, and two postprocedural amputations. There were no puncture-related complications. PTA can be performed with a contralateral retrograde femoral puncture in a high percentage of patients, even when disease is well below the inguinal ligament.