Direct occluded vessel puncture technique as a new access site for complex peripheral artery occlusive disease

Abstract

A 77-year-old male was admitted to our hospital for severe intermittent claudication of both legs. He was diagnosed with aorto-iliac occlusions and a right femoro-popliteal artery occlusion with a diseased common femoral artery by a computed tomography angiography of the lower limb. We planned endovascular therapy for these multi-level occlusive lesions. The aorto-iliac lesion of the left side was antegradely recanalized via the left brachial artery. That of the right side was recanalized retrogradely by a direct occlusive vessel puncture (DOVP) with a dedicated 20 G needle and the Hi-Torque Command 18 ST. After stenting, his symptoms were completely relieved without revascularization of right femoropopliteal artery, and he was discharged without any complications. The DOVP may also be used as an alternative option when there is not an appropriate approach site. <Learning objective: The appropriate selection of the access site for peripheral artery occlusive disease (PAOD) is one of the most important factors to obtain a successful guidewire recanalization. We occasionally encounter multi-level PAOD without an appropriate access site. The direct occluded vessel puncture should be considered as an alternative option.>