Use of a percutaneous puncture needle for true lumen re-entry during subintimal recanalization of the superficial femoral artery

Failure of subintimal angioplasty commonly results from an inability to re-enter the true lumen. When re-entry devices are not available, an alternative is the retrograde approach. This case report describes three patients with superficial femoral artery occlusion treated by endovascular intervention that showed failure of re-entry into the true lumen after the subintimal approach. In these patients, re-entry was achieved by the use of a percutaneous needle inside the lumen at the proposed re-entry point. This needle creates an aperture in the intima. The antegrade wire is directed to this gap to slide beside the needle and to enter the true lumen.