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

Abstract

Infra-inguinal arterial chronic total occlusions remain a challenging scenario for the endovascular practitioner. Retrograde access has quickly become an essential tool in approaching such lesions, increasing the chances of crossing success. When antegrade and retrograde access techniques fail in achieving lesion crossing, re-entry devices have proven to be useful. Their use is however, somewhat limited by the size of the sheaths required to accommodate their passage. As newer and slimmer profiled sheaths become available, the possibilities of interventions available from minimally invasive approaches increases. We present 2 complex arterial revascularization cases that required intravascular ultrasound-based re-entry devices utilizing a pedal retrograde access.

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

“…25,28 In addition, the Pioneer Plus has also been described in two cases of retrograde deployment from dorsalis pedis artery access into the popliteal artery and into the SFA. 29 The Pioneer is particularly well-suited for use in the iliac arteries, where penetration of dense plaque is of greatest importance, and precise maneuverability is not as crucial as would be needed in the distal lower extremity vessels.…”