Transcollateral Retrograde Approach With Rendezvous Technique for Recanalization of Chronically Occluded Tibial Arteries

Abstract

urpose: To describe a novel technique using an antegrade wire in a retrograde microcatheter advanced through a transcollateral vessel for recanalization of challenging infrapopliteal chronic total occlusions. Technique: A 75-year-old diabetic man presented with critical limb ischemia manifested as nonhealing ulcers on the toes. Baseline angiography revealed a blunt, long, total occlusion of the anterior tibial artery. A retrograde microcatheter was advanced over a guidewire tracking the collateral channel from the planter artery. Antegrade and retrograde microcatheters were aligned inside the occluded lesion. An antegrade wire was then advanced further down through the retrograde microcatheter. Final angiography of the anterior tibial artery following balloon dilation demonstrated a satisfactory result, without evidence of significant residual stenoses or flow-limiting dissections. Complete wound healing was achieved at 3 weeks. Conclusion: This alternative wire method may be useful when traditional interventional approaches are unfeasible.

Percutaneous Transcollateral Retrograde Recanalization of Isolated Dissection of the Superior Mesenteric Artery

“…16 The transcollateral retrograde approach applying a rendezvous technique was initially used for recanalization of chronic total occlusions in the lower limbs. 17 Retrograde recanalization of the SMA can be achieved via collaterals from the celiac trunk and inferior mesenteric artery. 8,9 The middle colic artery, a proximal branch of the SMA, always connects with the distal trunk of the SMA through the marginal and ileocolic arteries.…”

Combined retrograde–antegrade arterial wiring: Peroneal artery can be a bridge to cross infrapopliteal Trans Atlantic Inter Society Consensus D lesions

“…In such situations, a trans-collateral retrograde approach is one of the optional techniques for BTK recanalization. 16,17 The peroneal artery often remains patent despite disease or occlusion of other infrapopliteal arteries. The peroneal artery communicates distally with the PTA via one to three transverse communicating branches and with the ATA via the anterior perforating branch.…”

Case Report of Percutaneous Retrograde Transcollateral Recanalization of the Superior Mesenteric Artery via the Celiac Artery for Acute Mesenteric Ischemia

“…Given she did not want a potential bowel resection, and a flush SMA occlusion which we could not cross antegrade, we resorted to trying to cross the SMA in a retrograde fashion using the transcollateral wiring technique. 1 , 2 …”

“…Urasawa et al 1 have described retrograde recanalization of superficial femoral artery using profunda femoris collaterals, whereas successful transcollateral recanalization of chronically occluded tibial arteries has also been demonstrated. 2 There have been a few reports of totally endovascular transcollateral recanalization of SMA in cases of chronic mesenteric ischemia 3 – 5 and also open laparotomy with retrograde SMA stenting; 6 however, totally endovascular retrograde transcollateral recanalization of SMA via the celiac artery (CA) has not been described in AMI.…”