Recanalization of flush iliac occlusions with the assistance of a contralateral iliac occlusive balloon

Abstract

Treating flush iliac artery occlusion by endovascular means can be very challenging and is a cause of technical failure requiring open surgical intervention. We describe a simple endovascular technique that can be valuable in increasing technical success and avoiding the use of a re-entry device. The technique involves placing an occlusive contralateral iliac artery balloon to assist in recanalizing a flush iliac artery occlusion.

Balloon Occlusion of the Contralateral Iliac Artery to Assist Recanalization of the Ipsilateral Iliac Artery in Total Aortoiliac Occlusion: A Technical Note

“…A recently published technical note described recanalization of a flush iliac occlusion with the assistance of a contralateral iliac occlusive balloon in a patient with a chronic total occlusion of the left CIA; the distal abdominal aorta and right CIA were patent [8]. We used a very similar technique: our patient; however, had a total aortoiliac occlusion.…”

“…Once one of the occluded iliac arteries is recanalized, crossing the contralateral iliac occlusion from a brachial approach can become more challenging, as the wire and catheter will follow the path of the least resistance into the recanalized iliac segment. A guiding sheath can provide support for the wire and catheter during recanalization; in the setting of flush CIA occlusion or aortoiliac occlusion, without a stump at the origin of the CIA, the guiding sheath can have difficulty engaging with the lesion, and the advantage of using the stiff support of the guiding sheath is negated [8]. The crossover recanalization approach is another alternative, where a curved diagnostic catheter, advanced from a contralateral femoral approach, is positioned at the aortic bifurcation with the tip engaging the stump of the iliac occlusion.…”

Novel Use of the “Contra Catheter” (CC) In Proximal Iliac Artery Chronic Total Occlusion (PICTO) Recanalization

“…Another approach that has been described for such cases involves use of a brachial approach with a 7Fr system with contralateral Iliac balloon occlusion for support [6,9]. Our approach is simpler and avoids balloon occlusion for support and brachial access with their associated risks.…”

“…PICTOs are especially challenging for endovascular approaches as these cases can be complicated by lack of equipment to be able to treat disease distal to the iliac via a radial approach and may require brachial [6] or axillary approach with associated risks. The most common reason for failure of an endovascular approach in CTOs is inability to cross the CTO with a guidewire [7].…”

Endovascular Management of Flush Common Iliac Artery Occlusive Disease: Challenges and Solutions

“…The technique involves placing an occlusive contralateral iliac artery balloon to assist in recanalizing a flush iliac artery occlusion, thus avoiding the expensive re-entry devices. 15 In Balzer et al and Treiman et al, the preferred approach in complete occlusion is to pass the lesion by contralateral approach, then all procedures as debulking and stent insertion were done from ipsilateral retrograde femoral. 8,16 Although using only retrograde ipsilateral femoral approach was preferred access used by Ballard et al, Sullivan et al, and Brountzos and Kelekis as it is short, straight, and successful in 80% of cases, yet it has several disadvantages that were mentioned by Thava et al, as it usually creates subintimal dissection which will be a problem in re-entry as thickened aortic intima heralds the re-entry and also dissection may reach to renal and lumbar causing serious effect.…”