Endovascular revascularization of chronic total arterial occlusion of the lower limb using the SAFARI technique

Abstract

The SAFARI technique or Subintimal Arterial Flossing with Antegrade-Retrograde Intervention is an endovascular procedure that allows recanalization of Chronic Total Occlusive (CTO) lesions when conventional subintimal angioplasty is unsuccessful. Retrograde access is usually obtained through the popliteal, anterior tibial, dorsalis pedis artery, or posterior tibial arteries and may potentially provide more options for endovascular interventions in limb salvage. The case of an 81-year-old man with a history of uncontrolled hypertension, diabetes mellitus, and dyslipidemia is presented. He presented with a cutaneous ulcer on the right lower limb with torpid evolution and poor healing. The Doppler ultrasound and arteriographic study revealed a CTO lesion of the popliteal artery that was not a candidate for antegrade endovascular revascularization, but was successfully treated using the SAFARI technique. The patient had no perioperative complications, the wound showed better healing, and he was discharged with an indication of daily dressings and control by an external outpatient clinic.

Successful extreme foot revascularization with plaque cracking (percutaneous direct needle puncture of calcified plaque) technique of medial tarsal artery

“… 4 When an endovascular approach is used, antegrade or retrograde recanalization will sometimes not successfully guarantee direct flow to the foot. 5 In the literature, extreme retrograde approaches have been proposed with direct puncture of foot arteries. 6 However, plaque cracking of tarsal vessels has not yet been reported.…”

“…The technique we describe in the present report is a modified PIERCE technique performed in association with the SAFARI (subintimal arterial flossing with antegrade–retrograde intervention) technique. 2 , 5 It can be used in patients with extremely calcified BTA vessels, where it is not possible to obtain antegrade recanalization. 7 In experienced hands, plaque cracking can be performed under ultrasound guidance.…”

Correlação entre o índice de resistência vascular e a arteriografia na avaliação do leito arterial distal na isquemia crítica dos membros inferiores

“…Até os dias atuais, a ASD continua sendo o exame padrão-ouro para o planejamento na cirurgia de revascularização dos MMII. Entretanto, a ASD é um exame invasivo, utiliza contraste iodado, expõe o paciente e a equipe médica à radiação ionizante e tem alto custo, além de possuir limitações como a visibilização do leito arterial distal (LAD) a uma oclusão que, por vezes, é inadequada [2][3][4] . A visibilização do leito distal pode ser dificultada quando o fluxo sanguíneo fica bastante reduzido, seja por múltiplas e longas oclusões, seja por débito cardíaco insuficiente, seja por importante dor isquêmica que impede que o paciente fique imóvel durante a injeção do meio de contraste.…”

Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia

“…However, DSA is an invasive examination, uses iodinated contrast, exposes the patient and medical team to ionizing radiation, and is expensive, in addition to having limitations, such as visualization of the arterial bed distal of an occlusion which can be inadequate. [2][3][4] Visualization of the distal bed may be difficult if blood flow is severely restricted, whether because of multiple and extensive occlusions, insufficient cardiac output, or intolerable ischemic pain that prevents the patient from remaining immobile during injection of the contrast. In such situations, visualization of the arterial bed of the leg and foot can be considerably compromised.…”