Puncture of the popliteal artery using a Doppler-equipped (SMART) needle in transpopliteal interventions

Abstract

The puncture of the popliteal artery for percutaneous intervention is usually performed under fluoroscopic guidance or with the assistance of percutaneous ultrasound to avoid accidental arteriovenous fistulas. We present our experience in 119 cases with the use of a Doppler ultrasound equipped Seldinger needle (SMART needle) for the detection and puncture of the popliteal artery. In 119 interventions in 103 patients, the puncture of the popliteal artery was performed with the SMART needle. The puncture was successful in 94.1% (112 of 119) of cases. Six (5.2%) complications occurred during puncture: four hematomas (no therapy required) and two arteriovenous fistulas (treated by manual compression solely). The subsequent 112 interventions in 103 patients [98 percutaneous transluminal angioplasty (PTA), 8 PTA with stent implantations, 4 PTA with thrombolysis, 2 thrombolyses] were technically successful in 79.5% (89 of 112). The SMART-needle-guided popliteal puncture showed to be safe, fast, and easy to perform, which allowed the use of this technique by radiologists in training. The rates of success and complications are comparable to reported results for other visualization techniques, whereas time, effort, and training required are lower. This may contribute to a more widespread use of the transpopliteal access for interventions and therefore offers a therapeutic option in addition to vascular surgery.