Endovascular Treatment of Below-the-Knee Chronic Total Occlusions

2017 ◽  
pp. 45-74
Author(s):  
Anand Prasad ◽  
Fadi Saab
Keyword(s):  
Endovascular Treatment ◽  
Chronic Total Occlusions ◽  
Below The Knee

Antegrade vs Crossover Femoral Artery Access in the Endovascular Treatment of Isolated Below-the-Knee Lesions in Patients With Critical Limb Ischemia

2017 ◽  
Vol 24 (3) ◽  
pp. 331-336 ◽  
Author(s):  
Yukun Li ◽  
Ali Esmail ◽  
Konstantinos P. Donas ◽  
Georgios Pitoulias ◽  
Giovanni Torsello ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Success Rate ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Technical Success ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Below The Knee ◽  
Antegrade Approach

Purpose: To evaluate the safety and effectiveness of antegrade vs crossover femoral artery access in the endovascular treatment of isolated below-the-knee (BTK) lesions in patients with critical limb ischemia (CLI). Methods: Between January 2014 and December 2015, 224 high-risk patients (mean age 75.8±9.8 years; 151 men) with CLI underwent infragenicular interventions on 292 crural vessels in 3 European vascular centers. All patients had isolated TransAtlantic Inter-Society Consensus (TASC) C (n=26) or D (n=198) BTK lesions. Primary endpoints were freedom from access-related complications and technical success comparing the antegrade vs crossover access groups. Results: Balloon angioplasty was the most used treatment modality (169 vessels, 75.4%). The technical success rate was 88.4% in the entire cohort and 88.0% in the antegrade group vs 90.4% in the crossover group (p>0.99). In all patients, the technical success rate was higher for stenotic lesions (100%) vs occlusions (85.5%, p=0.002) and in patients with TASC C BTK lesions (100%) vs TASC D (86.9%, p=0.033). The overall freedom from access-related complications was 97.8%: 99% in the antegrade group and 90.6% in the crossover group (p=0.022). Larger sheath size (5/6-F vs 4-F) was associated with a significantly higher risk for access-related complications (7.1% vs 1.1%, respectively; p=0.047). Conclusion: The present multicenter study showed high technical success and a low incidence of access-related complications in the treatment of isolated BTK lesions using either antegrade or crossover femoral access. The antegrade approach with the use of a 4-F system seems to have a significantly lower rate of access-related complications.

Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach

2022 ◽  
pp. 152660282110687
Author(s):  
August Ysa ◽  
Marta Lobato ◽  
Ana M. Quintana ◽  
Leire Ortiz de Salazar ◽  
Roberto Gómez ◽  
...  
Keyword(s):  
Arterial Occlusion ◽  
Chronic Total Occlusions ◽  
Tibial Artery ◽  
Below The Knee ◽  
Angioplasty Balloon ◽  
Low Profile ◽  
Loop Technique ◽  
The Wire ◽  
Technique Failure

Purpose: To describe a novel bailout technique to approach below-the-knee chronic total occlusions after a failed bidirectional recanalization attempt using the plantar loop maneuver in patients who are poor candidates for a retrograde puncture. Technique: After a failure of recanalization of the opposite tibial artery using the plantar loop maneuver, an assisted direct retrograde transpedal approach can be performed regardless of poor vessel caliber or even arterial occlusion. After crossing the plantar arch, a low profile angioplasty balloon is used as a landmark for the pedal puncture and to give guidance for the wire advancement from the new access. Conclusion: A balloon-assisted retrograde transpedal approach may be considered for below-the-knee recanalization after standard plantar loop technique failure in patients who are not candidates for conventional retrograde puncture.

scholarly journals TCT-795 Technical success rates of endovascular treatment of femoropopliteal chronic total occlusions

2015 ◽  
Vol 66 (15) ◽  
pp. B323
Author(s):  
Thomas M. Das ◽  
Kyle Planchard ◽  
Denizen Kocak ◽  
Atif Mohammad ◽  
Ehrin J. Armstrong ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Success Rates ◽  
Technical Success ◽  
Chronic Total Occlusions

Endovascular treatment for unilateral chronic total occlusions of the iliac artery categorized as TASC II type D lesions

Surgery Today ◽  
2014 ◽  
Vol 45 (2) ◽  
pp. 162-167 ◽  
Author(s):  
Naokazu Miyamoto ◽  
Ryota Kawasaki ◽  
Tetsuya Fukuda ◽  
Masato Yamaguchi ◽  
Kazuro Sugimura ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Iliac Artery ◽  
Chronic Total Occlusions ◽  
Type D
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