{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T17:09:27Z","timestamp":1793812167161,"version":"4.6.1"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["CVIR Endovasc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Our study aims to evaluate the technical feasibility and safety of retrograde popliteal artery access (RPA) combined with rotational atherectomy and drug-coated balloon (DCB) angioplasty for complex femoropopliteal lesions, specifically without the use of distal embolic protection devices (EPD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center, single-operator, retrospective study enrolled 22 consecutive patients with TASC B and C femoropopliteal lesions treated between January 2021 and June 2025. All had severe claudication (Rutherford class 3) and calcified lesions. All underwent ipsilateral retrograde popliteal access, JetStream rotational atherectomy, and Ranger DCB post-dilatation (Boston Scientific) without embolic protection. Technical success, access-site safety, ankle\u2013brachial index (ABI), and 12-month patency were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean age was 69.9\u2009\u00b1\u20097.9\u00a0years; 18 (81.8%) were male. Technical success was 95.5% (one bailout stent). No embolic events, procedure-related deaths, amputations, or major complications occurred. One patient (4.5%) had a minor access-site hematoma. At 12\u00a0months (19 patients), Kaplan\u2013Meier analysis demonstrated a primary patency rate of 89.9% and a secondary patency rate of 100% (as all TLRs were successful). Two patients required clinically driven target lesion revascularization (TLR) at 6 and 10\u00a0months; freedom from TLR at 12\u00a0months was 89.9%. Mean ABI improved from 0.47\u2009\u00b1\u20090.07 to 0.85\u2009\u00b1\u20090.11 at 1\u00a0month (P\u2009&lt;\u2009.001) and remained stable at 12\u00a0months (0.86\u2009\u00b1\u20090.04).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>RPA combined with rotational atherectomy and DCB angioplasty without embolic protection was technically feasible and did not result in clinically detectable macroembolization. However, definitive conclusions regarding microembolic safety cannot be drawn from these data alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42155-026-00745-0","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T03:08:47Z","timestamp":1785294527000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Rotational atherectomy via retrograde popliteal access without embolic protection for complex femoropopliteal lesions"],"prefix":"10.1186","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9881-7240","authenticated-orcid":false,"given":"Onur","family":"Taydas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erbil","family":"Arik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Ali","family":"Durmus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed Said","family":"Besler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail","family":"Ozer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet Yasin","family":"Kabas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volkan","family":"Tasci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer Faruk","family":"Topaloglu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahrettin Yusuf","family":"Altintas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Ozdemir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Halil","family":"Ozturk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bulent","family":"Arslan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"745_CR1","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1016\/S0140-6736(13)61249-0","volume":"382","author":"FG Fowkes","year":"2000","unstructured":"Fowkes FG, Rudan D, Rudan I, et al. 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Ann Vasc Surg. 2024;107:136\u20139.","journal-title":"Ann Vasc Surg"}],"container-title":["CVIR Endovascular"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00745-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42155-026-00745-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00745-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T18:12:49Z","timestamp":1785521569000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42155-026-00745-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["745"],"URL":"https:\/\/doi.org\/10.1186\/s42155-026-00745-0","relation":{},"ISSN":["2520-8934"],"issn-type":[{"value":"2520-8934","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]},"assertion":[{"value":"17 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval for this retrospective study was obtained from the local ethics committee (E-43012747-050.04-481649-365\/June 17, 2025). Informed consent was waived due to the retrospective nature of the study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"92"}}