Successful outside-the-stent stenting for in-stent chronic total occlusion in the common iliac artery

Growing endovascular strategies with TASC D lesions in aortoiliac disease reflect increasing technical success with evidenced safety and efficacy. In cases of failed transfemoral access, revascularization of iliac chronic total occlusions has prompted the utilization of other alternate access sites (e.g. transradial and transbrachial approaches) as important options in aortoiliac TASC D lesions. We describe a case of successful revascularization of an occluded ostial left common iliac artery in an 81-year-old man using a dual ulnar and tibioperoneal approach (absent radial artery). A Controlled Antegrade and Retrograde Tracking technique was performed where a balloon was advanced from the peroneal artery into the distal cap of the chronic total occlusion in the proximal common femoral artery. Balloon inflation was performed and a glidewire from transulnar access was advanced and re-entered into the true lumen in the common femoral artery. The wire was then snared and externalized out the transpedal access site creating a continuous true lumen from the ulnar artery to the peroneal artery. To reconstruct the aortic bifurcation, kissing balloon inflations were performed from the peroneal as well as the ulnar artery approaches. A 10 mm × 59 mm balloon expandable stent was placed in the ostial left common iliac artery and a 8 mm × 60 mm self-expanding stent was placed in the left external iliac artery successfully.

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Heavily calcified chronic total occlusion of common iliac artery successfully treated with Tornus microcatheter and rotational atherectomy

Journal of Vascular Surgery ◽

10.1016/j.jvs.2008.05.059 ◽

2008 ◽

Vol 48 (3) ◽

pp. 758-760 ◽

Cited By ~ 3

Author(s):

Masahiko Hara ◽

Masami Nishino ◽

Ken Matsuoka ◽

Yoshio Yamada

Keyword(s):

Iliac Artery ◽

Chronic Total Occlusion ◽

Common Iliac Artery ◽

Rotational Atherectomy ◽

Total Occlusion

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The feasibility of the flower stenting technique for ostial lesions of the common iliac artery

Health Science Reports ◽

10.1002/hsr2.343 ◽

2021 ◽

Vol 4 (3) ◽

Author(s):

Toshihiko Kishida ◽

Keisuke Hirano ◽

Shinsuke Mori ◽

Masahiro Yamawaki ◽

Norihiro Kobayashi ◽

...

Keyword(s):

Iliac Artery ◽

Common Iliac Artery ◽

The Common

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Treatment of an external iliac artery chronic total occlusion using alternate access sites

CVIR Endovascular ◽

10.1186/s42155-019-0089-6 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

Justin Ratcliffe ◽

Mike Gorenchtein ◽

Pankaj Khullar ◽

Abel Casso Dominguez ◽

Mohan Satish ◽

...

Keyword(s):

Iliac Artery ◽

Chronic Total Occlusion ◽

External Iliac Artery ◽

Arterial Disease ◽

Patient Comfort ◽

Vascular Lesions ◽

Symptom Improvement ◽

Total Occlusion ◽

Maximal Medical Therapy ◽

Peripheral Arterial

Abstract Background With the advent of endovascular techniques, alternate sites such as the pedal and radial arteries can now be accessed when treating peripheral arterial disease to reduce procedural complications, shorten recovery time, and improve patient comfort. However, a paucity of literature exists on the availability of support devices that can be utilized during challenging cases. Case presentation A 70 year-old female patient presented for evaluation of severe lifestyle-limiting left-sided claudication refractory to maximal medical therapy. Angiography revealed a chronic total occlusion of the left external iliac artery, which was treated successfully by percutaneous intervention via a primary transpedal approach and with the assistance of the Outback® Elite re-entry device. The patient was discharged 2 h after the procedure and reported significant symptom improvement at follow-up. Conclusion This case highlights a newly adopted endovascular approach through an alternate access site and illustrates how the Outback® Elite device can be used as an adjunctive tool in the treatment of complex lower-extremity vascular lesions.

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