Retrograde Tibioperoneal Access for Complex Infrainguinal Occlusions

Schmidt, Andrej; Bausback, Yvonne; Piorkowski, Michael; Wittig, Tim; Banning-Eichenseer, Ursula; Thiele, Holger; Aldmour, Samer; Branzan, Daniela; Scheinert, Dierk; Steiner, Sabine

doi:10.1016/j.jcin.2019.06.048

Cited by 49 publications

(10 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Multiple distal puncture sites have been developed for vascular access to-date, and their safety and efficacy have been demonstrated in clinical settings (Palena and Manzi, 2012 , Nakama et al 2017a , b ; Schmidt et al 2019 ). To be noted, distal puncture is not a method only for retrograde access.…”

Section: Discussionmentioning

confidence: 99%

Inframalleolar thrice distal puncture in a single endovascular treatment session for successful revascularization

et al. 2023

View full text Add to dashboard Cite

Background Most patients with chronic limb-threatening ischemia (CLTI) have infrapopliteal arterial disease, which are often challenging to treat. In endovascular treatment (EVT) for these complex lesions, establishing retrograde access is an essential option not only for guidewire crossing but also for device delivery. However, no EVT case has yet been reported requiring inframalleolar thrice distal puncture in a single EVT session so far. Case presentation A 60-year-old CLTI patient with grade 3 Wound, Ischemia and foot Infection (WIfI) classification underwent EVT for occluded dorsal artery and posterior tibial artery. First, we conducted successful balloon angioplasty of the posterior tibial artery by establishing a retrograde approach via the lateral plantar artery. To treat the occlusion of the dorsal artery, we punctured the first dorsal metatarsal artery, and retrogradely advanced a guidewire to the dorsal artery occlusion; however, the microcatheter could not follow the guidewire. Therefore, we punctured the occluded distal anterior tibial artery and introduced the retrograde guidewire into the puncture needle. After guidewire externalization, we pulled up the retrograde microcatheter into the occlusion of dorsal artery using the “balloon deployment using forcible manner” technique. Thereafter, we were able to advance the antegrade guidewire into the retrograde microcatheter. After guidewire externalization, an antegrade balloon catheter was delivered and inflated for the purpose of dorsal artery dilation and hemostasis at the “needle rendezvous” point. Consecutively, balloon dilation was performed for puncture site hemostasis of the first dorsal metatarsal artery and complete hemostasis was achieved. Finally, we confirmed good vascular patency and favorable blood flow. After revascularization, transmetatarsal amputation was performed and the wound healed favorably. Conclusions We can markedly increase the success rate of revascularization by effectively utilizing the retrograde approach in EVT for complex chronic total occlusions in infrapopliteal arterial diseases.

show abstract

Section: Discussionmentioning

confidence: 99%

Inframalleolar thrice distal puncture in a single endovascular treatment session for successful revascularization

et al. 2023

View full text Add to dashboard Cite

show abstract

“…The retrograde access makes the crossing of chronic total occlusions more likely and makes it feasible to use an endovascular approach in patients with complex CLTI [Schmidt et al, 2019]. This may be due to the cap theory [Giannopoulos et al, 2021], which states that some CTO lesions are easier to cross depending on the morphology of their proximal and distal caps during angiographic imaging, assuming the direction of ow.…”

Section: Discussionmentioning

confidence: 99%

Endovascular retrograde tibial access for limb salvage in Chronic Limb-Threatening Ischemia: A Case Report

Isaza-Meza

Corso-Ramírez

Florez-Amaya

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: Peripheral artery disease is a chronic disorder characterised by stenosis and/or occlusion of peripheral large and medium-sized arteries. It most commonly affects the lower limbs, causing claudication, and foot ulcers/gangrene, which if not treated correctly can lead to Chronic Limb-Threatening Ischemia. This condition requires revascularization to improve limb perfusion and limit the risk of amputation. Case presentation: We describe the case of a 76-year-old Latin American male who presented to the emergency department with ischemic rest pain and ulceration of the left limb. Angiotomography showed severe stenosis in the left common femoral, superficial femoral, and popliteal left arteries. Percutaneous angioplasty intervention was made to restore the blood flow and limb salvage. A retrograde approach was obtained via ultrasonography-guided tibial anterior artery puncture. The post-procedural course was uneventful. The retrograde puncture technique allowed adequate blood flow without complications. Follow-up 2 months later showed resolution of foot ulcer. Conclusions: There are still limited studies available to evaluate the effectiveness and long-term success of tibio-pedal access for revascularization, nevertheless, it shows a promising option for patients with poor surgical options in need of urgent intervention.

show abstract

“…A retrograde approach to the lesion increases the success rate considerably, is safe, and can be performed in several ways via different arteries. However, the available reports come from rather high-volume expert centres 7,13 and a considerable learning curve must be overcome to perform these procedures. In daily practice, a retrograde approach using tibial or pedal access still represents a hurdle for many interventionalists.…”

Section: Discussionmentioning

confidence: 99%

“…These techniques have been previously described. 7,11 The treated lesion could be in the iliac, femoropopliteal, or tibial segment.…”

Section: Methodsmentioning

confidence: 99%

“…5,6 The retrograde access to infrainguinal arteries is another alternative when an antegrade recanalization attempt fails, but interventionalists may have restrains to adopt this technique due to technical and safety concerns. 7 Even then, failure may still occur and a combination of these technologies and techniques, for example, crossing-device and re-entry system may become necessary, increasing the costs, duration, and complexity of the procedure. To simplify and potentially improve the success rate of complex CTO recanalization, an ideal device should allow its application for both lesion crossing and distal re-entry as well as its use via antegrade and distal retrograde access.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

First Experience With The GoBack-Catheter For Successful Crossing of Complex Chronic Total Occlusions in Lower Limb Arteries

et al. 2021

Self Cite

View full text Add to dashboard Cite

Purpose: To evaluate the use of the GoBack-catheter (Upstream Peripheral Technologies) in complex revascularizations in lower limb arteries. Materials and Methods: In this retrospective single-center study, the results of the first 100 consecutive patients including 101 limb-revascularizations, performed between May 2018 and July 2020 with the study device, were analyzed. In all cases, guidewire-crossing failed, and all lesions were chronic total occlusions (CTO), either de novo, reocclusions, or in-stent reocclusions. Successful crossing was defined as passing the CTO using the study device. Patency at discharge and after 30 days was defined as less than 50% restenosis on duplex sonography, without target lesion revascularization. Results: Median lesion length was 24 cm and 38 patients (37.6%) had a calcium grading according to the peripheral arterial calcium scoring system (PACSS) of 4 or 5. In 20.8% of patients, an occluded stent was treated. CTOs involved the femoropopliteal segment in 91.1%, iliac arteries in 5.9%, and tibial arteries in 7.9%. The GoBack-catheter was employed for entering into or crossing through parts or the full length of a CTO or an occluded stent as well as for re-entering into the true lumen after subintimal crossing. The device was used via contralateral and ipsilateral antegrade as well as retrograde access with an overall technical success rate of 92.1%. In 3 patients minor bleeding occurred at the crossing or re-entry site, which were managed conservatively. Thirty-day adverse limb events comprised minor amputations in 4 patients (4.0%), 1 major amputation (1.0%), and reocclusions in 7 limbs (6.9%). Conclusion: The new GoBack-catheter offers versatile endovascular applicability for complex CTO recanalization in a broad range of peripheral vascular interventions with a high technical success and low complication rate.

show abstract

Retrograde Tibioperoneal Access for Complex Infrainguinal Occlusions

Cited by 49 publications

References 13 publications

Inframalleolar thrice distal puncture in a single endovascular treatment session for successful revascularization

Inframalleolar thrice distal puncture in a single endovascular treatment session for successful revascularization

Endovascular retrograde tibial access for limb salvage in Chronic Limb-Threatening Ischemia: A Case Report

First Experience With The GoBack-Catheter For Successful Crossing of Complex Chronic Total Occlusions in Lower Limb Arteries

Contact Info

Product

Resources

About