“…8 Therefore, we suggest the crossover contralateral approach to advance a .035' guidewire of 260 cm length within the EIA until it reaches the inguinal ligament level (Figure 1A), where the quidewire is secured. 9 When the CFA and distal EIA are occluded, we retrieve the wire directly from the CFA arteriotomy as soon as the anterior segment of the atherosclerotic plaque (Figure 1B) is removed. The endarterectomy process reaches the distal EIA with the wire in place (Figure 1C and D).…”
Section: Technical Notementioning
confidence: 99%
“…8 Therefore, we suggest the cross-over contralateral approach to advance a .035’ guidewire of 260 cm length within the EIA until it reaches the inguinal ligament level (Figure 1A), where the quidewire is secured. 9 Figure 1.(A) The crossover approach of a .035’ guidewire from the left to the rigth iliac axis facilitated via a roadmap guidance with a C-arm in the operating room. (B) The contralateraly inserted guidewire is retrieved from the femoral arteriotomy immediately after the anterior plaque is removed.…”
Background Management of a heavily calcified atherosclerotic occlusive disease involving the common femoral artery (CFA) and external iliac artery (EIA), poses a surgical challenge. Though the current guidelines recommend open surgical therapy for such lesions, this approach is neither easy nor represents the current real-life practice. Purpose To describe tips and tricks facilitating the hybrid technique for the management of distal iliofemoral atherosclerotic disease, where classic endarterectomy is inadequate or ill-performed. Technique A contralateraly inserted guidewire reaches the distal iliac artery via the crossover technique and is directly retrieved from the femoral arteriotomy immediately after removal of the anterior plaque segment. The retrieved and secured guidewire enables extensive retrograde CFA endarterectomy over the wire with avusion proximally to the inguinal ligement, followed by patch arterioplasty. Externalizing the guidewire from the patch enables traction on it and facilitates advancement of the stent through tortuous or stenosed iliac vessels as well as accurate stent deployment to cover the margin of the EIA residual plaque. Moreover, this manipulation enables ipsilateral placement of a sheath and passage of a second, retrograde guidewire to perform kissing stenting in the common iliac vessels. Chronic thrombotic lesions require covered stents to avoid thrombus propagation and meticulous flushing before completion of the femoral patching. Conclusions The combined iliofemoral endarterectomy with stenting does not require advanced endovascular skills and prevents complications associated with incomplete femoral endarterectomy. Extensive avulsion endarterectomy proximal to the inguinal ligament is efficiently and safely performed over a retrieved crossover guidewire, enabling precise residual stenting above the flexion site.
“…8 Therefore, we suggest the crossover contralateral approach to advance a .035' guidewire of 260 cm length within the EIA until it reaches the inguinal ligament level (Figure 1A), where the quidewire is secured. 9 When the CFA and distal EIA are occluded, we retrieve the wire directly from the CFA arteriotomy as soon as the anterior segment of the atherosclerotic plaque (Figure 1B) is removed. The endarterectomy process reaches the distal EIA with the wire in place (Figure 1C and D).…”
Section: Technical Notementioning
confidence: 99%
“…8 Therefore, we suggest the cross-over contralateral approach to advance a .035’ guidewire of 260 cm length within the EIA until it reaches the inguinal ligament level (Figure 1A), where the quidewire is secured. 9 Figure 1.(A) The crossover approach of a .035’ guidewire from the left to the rigth iliac axis facilitated via a roadmap guidance with a C-arm in the operating room. (B) The contralateraly inserted guidewire is retrieved from the femoral arteriotomy immediately after the anterior plaque is removed.…”
Background Management of a heavily calcified atherosclerotic occlusive disease involving the common femoral artery (CFA) and external iliac artery (EIA), poses a surgical challenge. Though the current guidelines recommend open surgical therapy for such lesions, this approach is neither easy nor represents the current real-life practice. Purpose To describe tips and tricks facilitating the hybrid technique for the management of distal iliofemoral atherosclerotic disease, where classic endarterectomy is inadequate or ill-performed. Technique A contralateraly inserted guidewire reaches the distal iliac artery via the crossover technique and is directly retrieved from the femoral arteriotomy immediately after removal of the anterior plaque segment. The retrieved and secured guidewire enables extensive retrograde CFA endarterectomy over the wire with avusion proximally to the inguinal ligement, followed by patch arterioplasty. Externalizing the guidewire from the patch enables traction on it and facilitates advancement of the stent through tortuous or stenosed iliac vessels as well as accurate stent deployment to cover the margin of the EIA residual plaque. Moreover, this manipulation enables ipsilateral placement of a sheath and passage of a second, retrograde guidewire to perform kissing stenting in the common iliac vessels. Chronic thrombotic lesions require covered stents to avoid thrombus propagation and meticulous flushing before completion of the femoral patching. Conclusions The combined iliofemoral endarterectomy with stenting does not require advanced endovascular skills and prevents complications associated with incomplete femoral endarterectomy. Extensive avulsion endarterectomy proximal to the inguinal ligament is efficiently and safely performed over a retrieved crossover guidewire, enabling precise residual stenting above the flexion site.
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