To anlyze the safety and efficacy of the relay puncture technique in treatment of arteriosclerosis obliterans of lower extremities in patients without contralateral femoral artery approach.

From April 2014 to September 2017, 22 cases of symptomatic peripheral arterial disease (PAD) without contralateral femoral access (5 cases with implantation of covered stents in the contralateral common femoral artery, kissing stents in aortoiliac lesion in 6 patients, 4 cases of abdominal aortic aneurysm endovascular repair, 3 patients with arotoiliac lesions involves bilateral femoral artery and 4 underwent limb amputation to the contralateral leg) were enrolled in. All cases used relay puncture technique for lesions revascularization over the same period. First, trans-brachial artery approach was used to recanalize ipsilateral iliac femoral artery, which could create a safety zone in ipsilateral femoral artery to puncture for revascularization of the femoropopliteal, even the artery below the knee, which was called relay puncture technique. The antegrade puncture on the femoral artery after the branchial artery puncture was just like a relay race. Post-operation success rate and complication were reported.

Success rate of operation was 100% with 103 stents deployed (4.7 stents per case) , and the ischemia symptoms decreased immediately after the treatment. Post-operation ankle-brachial index (ABI) was significantly higher than pre-operation (0.90±0.16 vs. 0.33±0.18, t=18.80, P<0.01) . All the patients were followed up for 2~36 (median time, 19.5) months, without serious complications during perioperative period and follow-up period. The 1-year primary patency rate was 81.8% (18/22) .

Relay puncture technique is a safe and effective method to revascularize the blood flow of patients with challenging artery lesions whose contralateral femoral artery cannot obtain and short-shaft of the devices through the brachial artery approach, and can be used as the preferred treatment.