Combined percutaneous direct puncture of occluded artery – antegrade intervention for recanalization of below the knee arteries

Fırat, Ali; Igus, Behlul

doi:10.5152/dir.2019.18580

Cited by 5 publications

(2 citation statements)

References 36 publications

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“…A significant advantage of this maneuver is that one can access the artery regardless of vessel disease, diameter, or patency. Although previous experiences in distal occluded retrograde punctures have been published, 9 this technique has the downside of having to re-enter into the true lumen with the antegrade wire beyond the distal puncture site. This is not always a straightforward maneuver, and it may eventually extend the dissection plane distally threatening the patency of the arch.…”

Section: Discussionmentioning

confidence: 99%

Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach

et al. 2022

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Purpose: To describe a novel bailout technique to approach below-the-knee chronic total occlusions after a failed bidirectional recanalization attempt using the plantar loop maneuver in patients who are poor candidates for a retrograde puncture. Technique: After a failure of recanalization of the opposite tibial artery using the plantar loop maneuver, an assisted direct retrograde transpedal approach can be performed regardless of poor vessel caliber or even arterial occlusion. After crossing the plantar arch, a low profile angioplasty balloon is used as a landmark for the pedal puncture and to give guidance for the wire advancement from the new access. Conclusion: A balloon-assisted retrograde transpedal approach may be considered for below-the-knee recanalization after standard plantar loop technique failure in patients who are not candidates for conventional retrograde puncture.

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Section: Discussionmentioning

confidence: 99%

Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach

et al. 2022

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“…The PTA is a predilection site for lower limb arterial occlusion (Anand et al, 2020; Firat & Igus, 2019). In addition, the tibial nerve (TN) is accompanied by the PTA.…”

Section: Introductionmentioning

confidence: 99%

An anatomical study of the tibial nerve branches innervating the posterior tibial artery

et al. 2022

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The arteries of the lower limbs are innervated by vascular branches (VBs) originating from the lumbar sympathetic trunk and branches of the spinal nerve. Although lumbar sympathectomy is used to treat nonreconstructive critical lower limb ischemia (CLLI), it has limited long‐term effects. In addition, the anatomical structure of tibial nerve (TN) VBs remain incompletely understood. This study aimed to clarify their anatomy and better inform the surgical approach for nonreconstructive CLLI. Thirty‐six adult cadavers were dissected under surgical microscopy to observe the patterns and origin points of VBs under direct vision. The calves were anatomically divided into five equal segments, and the number of VB origin points found in each was expressed as a proportion of the total found in the whole calf. Immunofluorescence staining was used to identify the sympathetic nerve fibers of the VBs. Our results showed that the TN gave off 3–4 VBs to innervate the posterior tibial artery (PTA), and the distances between VBs origin points and the medial tibial condyle were: 24.7 ± 16.3 mm, 91.7 ± 66.1 mm, 199.6 ± 52.0 mm, 231.7 ± 38.5 mm, respectively. They were mainly located in the first (40.46%) and fourth (31.68%) calf segments, and immunofluorescence staining showed that they contained tyrosine hydroxylase‐positive sympathetic nerve fibers. These findings indicate that the TN gives off VBs to innervate the PTA and that these contain sympathetic nerve fibers. Therefore, these VBs may need to be cut to surgically treat nonreconstructable CLLI.

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Percutaneous retrograde puncture of occluded common femoral artery combined with SAFARI for recanalization of iliac-femoral-BTK arterial occlusion

Chen,

Liu,

Chen

et al. 2023

Annals of Vascular Surgery - Brief Reports and Innovations

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Combined percutaneous direct puncture of occluded artery – antegrade intervention for recanalization of below the knee arteries

Cited by 5 publications

References 36 publications

Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach

Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach

An anatomical study of the tibial nerve branches innervating the posterior tibial artery

Percutaneous retrograde puncture of occluded common femoral artery combined with SAFARI for recanalization of iliac-femoral-BTK arterial occlusion

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