Comparative Assessment of Crossing and Reentry Devices in Treating Chronic Total Occlusions for Femoropopliteal and Below-the-Knee Interventions

2017 ◽  
pp. 75-94
Author(s):  
Nicolas W. Shammas
Keyword(s):  
Comparative Assessment ◽  
Chronic Total Occlusions ◽  
Below The Knee

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.

Comparative Assessment of Guidewire and Microcatheter vs a Crossing Device–Based Strategy to Traverse Infrainguinal Peripheral Artery Chronic Total Occlusions

2015 ◽  
Vol 22 (4) ◽  
pp. 525-534 ◽  
Author(s):  
Subhash Banerjee ◽  
Karan Sarode ◽  
Apurva Patel ◽  
Atif Mohammad ◽  
Roosha Parikh ◽  
...  
Keyword(s):  
Comparative Assessment ◽  
Peripheral Artery ◽  
Chronic Total Occlusions

Prediction of successful guidewire crossing of below-the-knee chronic total occlusions using a Japanese scoring system

2021 ◽  
Author(s):  
Michinao Tan ◽  
Daisuke Ueshima ◽  
Kazushi Urasawa ◽  
Naoki Hayakawa ◽  
Yutaka Dannoura ◽  
...  
Keyword(s):  
Scoring System ◽  
Chronic Total Occlusions ◽  
Below The Knee

scholarly journals The Retrograde Approach As an Alternative for Failed Antegrade Access for Difficult Below the Knee Chronic Total Occlusions

2019 ◽  
Vol 25 (4) ◽  
pp. 587-593
Author(s):  
Tarek Abd El-Latif ◽  
Ayman Salem ◽  
Abd Elrahman Gameel ◽  
Abdulmunem Allafi
Keyword(s):  
Retrograde Approach ◽  
Chronic Total Occlusions ◽  
Below The Knee

scholarly journals The “Direct Tip Injection in Occlusive Lesions (DIOL)” Fashion.

2021 ◽  
Author(s):  
Takuya Haraguchi ◽  
Tsutomu Fujita ◽  
Yoshifumi Kashima ◽  
Tsujimoto Masanaga ◽  
Tomohiko Watanabe ◽  
...  
Keyword(s):  
Balloon Catheter ◽  
Arterial Occlusion ◽  
Artery Occlusion ◽  
Hydraulic Pressure ◽  
Chronic Total Occlusions ◽  
Below The Knee ◽  
Contrast Volume ◽  
Artery Disease ◽  
Tip Position ◽  
Tip Injection

Abstract Background: The successful intervention for peripheral artery disease is limited by complex chronic total occlusions (CTOs). During CTO wiring, without the use of intravascular or extravascular ultrasound, the guidewire position is unclear, except for calcified lesions showing the vessel path. To solve this problem, we propose a novel guidewire crossing with plaque modification method for complex occlusive lesions, named the “Direct tip Injection in Occlusive Lesions (DIOL)” fashion.Main text: The “DIOL” fashion utilizes the hydraulic pressure of tip injection with a general contrast media through a microcatheter or an over-the-wire balloon catheter within CTOs. The purposes of this technique are 1) to visualize the “vessel road” of the occlusion from expanding a microchannel, subintimal, intramedial, and periadventitial space with contrast agent and 2) to modify plaques within CTO to advance CTO devices safely and easily. This technique creates dissections by hydraulic pressure. Antegrade-DIOL may create dissections which extend to and compress a distal lumen, especially in below-the-knee arteries. A gentle tip injection with smaller contrast volume (1-2 ml) should be used to confirm the tip position which is inside or outside of a vessel. On the other hand, retrograde-DIOL is used with a forceful tip injection of moderate contrast volume up to 5-ml to visualize vessel tracks and to modify the plaques to facilitate the crossing of CTO devices. Case-1 involved a severe claudicant due to right superficial femoral artery occlusion. After the conventional bidirectional subintimal procedure failed, we performed two times of retrograde-DIOL fashion, and the bidirectional subintimal planes were successfully connected. After two stents implantation, a sufficient flow was achieved without complications and restenosis for two years. Case-2 involved multiple wounds in the heel due to ischemia caused by posterior tibial arterial occlusion. After the conventional bidirectional approach failed, retrograde-DIOL was performed and retrograde guidewire successfully crossed the CTO, and direct blood flow to the wounds was obtained after balloon angioplasty. The wounds heeled four months after the procedure without reintervention.Conclusions: The DIOL fashion is a useful and effective method to facilitate CTO treatment.

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