Popliteal Artery chronic total occlusion in the patient with CLI

A chronic total occlusion (CTO) of the popliteal artery with critical limb ischaemia (CLI) represents a severe blockage behind the knee that has caused critically reduced blood flow to the foot and lower leg. CLI is characterised by rest pain, non-healing wounds, or tissue loss, and represents a limb-threatening condition requiring urgent intervention.

Popliteal CTOs present unique challenges due to the artery’s location at the knee, where it is subject to constant flexion and mechanical stress. The calcification often present in these lesions and the need to maintain flexibility of the treated segment make device selection and technical approach critical to achieving durable results.

Modern endovascular techniques for popliteal CTOs include angioplasty, self-expanding nitinol stents, covered stents such as the GORE VIABAHN, and drug-eluting balloons. The choice of approach depends on the length and calcification of the lesion and the specific anatomy below the knee.

The primary goal is limb salvage by restoring adequate blood flow to heal wounds and relieve rest pain. In patients with CLI, the urgency of intervention is high, as untreated critical ischaemia can progress rapidly to major amputation. Achieving durable patency of the treated vessel is important to maintain the benefit of treatment.

Following treatment, wound care and close monitoring are continued while the limb recovers. Antiplatelet medications are essential. Regular follow-up with duplex ultrasound assesses patency of the treated segment. Ongoing management of cardiovascular risk factors is an important part of long-term care.