Successful re-entry using the outback® elite catheter via retrograde popliteal access with IVUS guidance for femoropopliteal occlusion: a case report

Abstract

Background: There are still cases that are difficult to treat for femoropopliteal chronic total occlusion (CTO). The Outback® Elite catheter is effective re-entry device to treat such kind of difficult cases, however, it might be difficult to use the Outback® Elite catheter antegradely in cases with severely calcified lesions. In this case, we performed EVT using the Outback Elite® catheter via the retrograde popliteal approach. Case presentation: We report a case of a 77-year-old male with end-stage renal disease who presented with pain and cyanosis of his left foot. Control angiography showed total occlusion from the middle of the left superficial femoral artery to the proximal portion of the popliteal artery. The CTO lesion was severely calcified, which prevented the antegrade advancement of any guidewire. Retrograde popliteal puncture was performed with the patient in the supine position. After intentional retrograde subintimal wiring, the Outback® Elite catheter was advanced via the retrograde approach after the identification of a suitable re-entry site using intravascular ultrasound. After wire crossing, one nitinol stent was deployed and sufficient antegrade flow was achieved without any complications. Conclusions: Using Outback® Elite from retrograde should be considered in cases where antegrade advancement fails and bidirectional wiring cannot pass through the CTO lesion.

The Use of Re-Entry Devices Through Pedal Arterial Access in the Management of Chronic Limb-Threatening Ischemia

“…The trans-popliteal, trans-tibial, and trans-peroneal approaches have also been described. [10][11][12] Gorenchtein et al described 17 patients who underwent revascularization of femoral-popliteal CTO lesions via trans-tibial and trans-peroneal approaches. 10 In their series, all patients were successfully revascularized in an outpatient setting, with evidence of revascularization via ultrasound studies 1 month postintervention, without any access site complications.…”

Percutaneous Intentional Extraluminal Recanalization of Chronic Total Occlusions: A Review of Reentry Devices

“…Studies have demonstrated efficacious use of Outback catheter for reentry from retrograde femoropopliteal, crural, or pedal access to the femoral, popliteal, or below-the-knee arteries. 24,39,40 The largest of these showed a 91% success rate of recanalization in 45 patients with an 11% complication rate including two distal emboli and three bleeding episodes. 24 The authors noted an increasing preference for the sheathless use of the 5.9-Fr Outback catheter, which is a lower profile than the 8-Fr outer diameter of the required sheath.…”