Comparison of transfemoral vs transbrachial approach for angioplastic reconstruction of chronic total aortoiliac occlusion

Abstract

The angioplasty of chronic total aortoiliac occlusion using transfemoral is controversial. From March 2014 to December 2015, four consecutive patients (4 males; mean age 58.2±6.8 years; age of range 51-65 years) underwent angioplasty and stenting of TASC-D occlusion. In all the cases, we failed to cross from femoral approach. On switching over to left brachial access, angioplasty was done successfully in all. There was no procedural site complication or clinical evidence cerebral thromboembolism. Self-expandable stents were implanted in all with adequate pre and post dilation. Complete revascularisation was achieved in two cases and in other two cases, the angioplasty to the left aortoiliac carina was staged. Therefore, it is better to avoid femoral approach as initial step to cross chronic TASC 2007 type D (chronic total aortoiliac occlusion or called extensive aortoiliac disease) because of failure to cross retrogradely due to subintimal course of guide wire leading to retrograde aortic dissection.

Dual alternate access sites for the treatment of an ostial left common iliac artery chronic total occlusion

“…1–3 Specifically, revascularization of iliac chronic total occlusions (CTOs) has been achieved with transfemoral, transradial, and transbrachial arterial approaches. 4,5 However, anatomical variations and radial artery spasm can complicate transradial access. Similarly, transbrachial access has its own risk profile along with hand ischemia and difficulty in achieving post-procedural hemostasis.…”