A novel technique for preventing distal embolism during endovascular therapy for femoropopliteal lesions: The flow-controlled anti-embolic technique.

Distal embolism is a significant complication during endovascular therapy (EVT) for femoropopliteal (FP) lesions. This study describes a novel technique, the flow-controlled anti-embolic technique (FCAT), designed to prevent distal embolism during complex FP-EVT. The FCAT procedure involves three key steps. First, a balloon-guiding catheter is placed proximal to the target lesion to achieve antegrade flow arrest. Second, an external arteriovenous shunt is created between the femoral artery and vein, establishing continuous flow reversal through collateral pathways. Third, a blood filtration system incorporated within the shunt captures any liberated embolic debris. After establishing flow reversal, standard procedure is initiated. We prospectively evaluated this technique in 31 consecutive patients undergoing EVT for symptomatic FP disease. Technical success of the FCAT procedure was 100%. The primary outcome, angiographically evident distal embolism, did not occur in any patient. Macroscopic embolic debris was captured by the filtration system in all cases, confirming the technique's effectiveness in preventing particle embolization. No major procedure-related complications were observed. The FCAT is a safe and effective technique for preventing distal embolism during complex FP-EVT. By establishing flow reversal before and during intervention, it comprehensively protects the distal vascular bed from distal embolization during any FP-EVT.