Precise Retrograde Supera Stenting of the Ostium (PRESTO) of the Superficial Femoral Artery for Complex Femoropopliteal Occlusions: The PRESTO Technique

2018 ◽  
Vol 25 (5) ◽  
pp. 588-591 ◽  
Author(s):  
Luis M. Palena ◽  
Larry J. Diaz-Sandoval ◽  
Laiq M. Raja ◽  
Luis Morelli ◽  
Marco Manzi
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Limb Ischemia ◽  
Posterior Tibial Artery ◽  
Anterior Tibial Artery ◽  
Access Site ◽  
Total Occlusion ◽  
Arterial Access ◽  
Tibial Artery ◽  
Anterior Tibial

Purpose: To describe a novel technique designed to safely and precisely deploy the Supera stent accurately at the ostium of the proximal superficial femoral artery (SFA) without compromising the profunda and common femoral arteries. Technique: After antegrade crossing of the chronic total occlusion (CTO) at the SFA ostium and accurate predilation of the entire SFA lesion, a retrograde arterial access is obtained. The Supera stent is navigated in retrograde fashion to position the first crown to be released just at the SFA ostium. Antegrade dilation is performed across the retrograde access site to obtain adequate hemostasis. The technique has been applied successfully in 21 patients (mean age 78.1±8.2 years; 13 men) with critical limb ischemia using retrograde Supera stenting from the proximal anterior tibial artery (n=6), the posterior tibial artery (n=2), retrograde stent puncture in the mid to distal SFA (n=2), the native distal SFA/proximal popliteal segment (n=6), and the distal anterior tibial artery (n=5). No complications were observed. Conclusion: Distal retrograde Supera stent passage and reverse deployment allow precise and safe Supera stenting at the SFA ostium.

scholarly journals Retrograde Tibiopedal Access as a Bail-Out Procedure for Endovascular Intervention Complications

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Ahmed Amro ◽  
Alaa Gabi ◽  
Adee Elhamdani ◽  
Naveed Iqbal ◽  
Mehiar El-Hamdani
Keyword(s):  
Limb Salvage ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Superficial Femoral Artery ◽  
Limb Ischemia ◽  
Posterior Tibial Artery ◽  
Covered Stent ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Bail Out

Introduction. Retrograde pedal access has been well described in the literature as a secondary approach for limb salvage in critical limb ischemia (CLI) patients. In this manuscript we are presenting a case where retrograde tibiopedal access has been used as a bail-out procedure for the management of superficial femoral artery (SFA) intervention complications.Procedure/Technique. After development of a perforation while trying to cross the totally occluded mid SFA using the conventional CFA access, we were able to cross the mid SFA lesion after accessing the posterior tibial artery in a retrograde fashion and delivered a self-expanding stent which created a flap that sealed the perforation without the need for covered stent.Conclusion. Retrograde tibiopedal access is a safe and effective approach for delivery of stents from the distal approach and so can be used as a bail-out technique for SFA perforation.

Evaluation of Arterial Injury Due to Balloon Angioplasty by 111In-Labelled Platelets

1983 ◽  
Vol 22 (06) ◽  
pp. 324-328
Author(s):  
R. L. Hill-Zobel ◽  
M. F. Tsan ◽  
S. Kadir
Keyword(s):  
Femoral Artery ◽  
Balloon Angioplasty ◽  
Superficial Femoral Artery ◽  
Peripheral Circulation ◽  
Arterial Injury ◽  
Anterior Tibial Artery ◽  
Tibial Artery ◽  
Anterior Tibial ◽  
Platelet Accumulation ◽  
Sensitive Method

The sensitivity of 111In-labelled platelets for the detection of intimai trauma following balloon angioplasty was evaluated in 8 arteries in 6 patients. Focal platelet accumulation was detected at all 3 iliacs, one superficial femoral and the anterior tibial artery angioplasty sites. Minimal platelet accumulation was present at the superficial femoral artery angioplasty site in another patient whereas in both renal arteries no focal platelet accumulation was detectable. These results indicate that 111In-labelled platelets may provide a sensitive method for evaluation platelet accumulation at the balloon angioplasty site in the peripheral circulation.

Erratum

2002 ◽  
Vol 9 (5) ◽  
pp. A-6-A-6
Keyword(s):  
Limb Ischemia ◽  
Posterior Tibial Artery ◽  
Long Term Results ◽  
Peroneal Artery ◽  
Royal Infirmary ◽  
Anterior Tibial Artery ◽  
Tibial Artery ◽  
Anterior Tibial ◽  
Leicester Royal Infirmary

In the August 2002 issue, there was an error in the printed version of the article “Subintimal Angioplasty of Isolated Infragenicular Vessels in Lower Limb Ischemia: Long-term Results” by Ingle et al. (J Endovasc Ther. 2002;9:411–416). In the Methods sections of the abstract and the text (pages 411 and 412), the dimension of occlusion length was erroneously given as millimeters instead of centimeters; the corrected sentence reads: The median length of occlusion was 6 cm (range 1–10) in the below knee popliteal arteries, 4 cm (range 1–4) in the tibioperoneal trunk, 21 cm (range 1–35) in the anterior tibial artery, 10 (1–30) in the posterior tibial artery, and 5 (range 1–20) in the peroneal artery. We apologize to Mr. Ingle and his coauthors at the Leicester Royal Infirmary for this editing error. The online record of the article in both HTML and print versions has been corrected.

Abstract 16853: Retrograde Peripheral Limb Perfusion for Formidable Femoral Arterial Access in Veno-Arterial ECMO Treatment

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Laszlo Gobolos ◽  
Maurice Hogan ◽  
Vivek Kakar ◽  
Stefan Sanger ◽  
Nuno Raposo ◽  
...  
Keyword(s):  
Posterior Tibial Artery ◽  
The Body ◽  
Anterior Tibial Artery ◽  
Arterial Perfusion ◽  
Arterial Access ◽  
Tibial Artery ◽  
Limb Perfusion ◽  
Va Ecmo ◽  
Ultrasonographic Guidance ◽  
Peripheral Arterial

Introduction: VA ECMO has emerged to a well-established therapeutic method in severe acute heart failure. In the case of peripheral ECMO placement, especially applying direct arterial cannulation, the limb perfusion is often compromised by an occlusive effect of the cannula positioned in the femoral artery. The classical proximal femoral arterial reperfusion branch provides sufficient blood flow via a small auxiliary cannula, but in patients with severe peripheral arterial vasculopathy or with significant tissue depth resulting from obesity, the placement of a peripheral arterial perfusion loop may pose a technical challenge. Methods: In case of emerging peripheral ischemic symptoms at femoral VA ECMO placement, ultrasound scanning of the lower limb vessels is performed. In an uncomplicated vascular situation, antegrade distal perfusion can be established. If a significant vasculopathy is present in the proximal vessels, or any further hindrances, including extreme obesity, physically not allowing a subtle perfusion cannula placement resulting from the discrepancy between the tissue depth and cannula length, retrograde peripheral perfusion could be established via the dorsal pedal artery utilising the Seldinger method. An ultrasonographic guidance is essential; hence there is sometimes no backflow present on the inserted cannula in a critically ischemic limb. Following sufficient de-airing manoeuvres, the retrograde femoral flow can be safely established; NIRS confirms the successful reperfusion in a short timeframe. If the dorsal pedal artery is not sufficient for cannulation purposes, the postmalleolar posterior tibial artery segment or the anterior tibial artery through the similarly named muscle can be utilised for cannulation purposes. Results: Two patients showed a pre-reperfusion calf saturation of 29% and 38%, which has increased to 61% and 64% after re-establishing the distal flow within minutes, respectively. We have experienced no complications emerging during the application of the above method. Conclusions: In case of peripheral vascular disease or the body habitus does not allow safe installation of an antegrade flow device, our retrograde perfusion option can save the affected limb on VA ECMO therapy.

Femoral Balloon-Oriented Puncture for True Lumen Reentry in the Common Femoral Artery After Subintimal Retrograde Recanalization of Superficial Femoral Artery Ostial Occlusion: The FORLEE Technique

2019 ◽  
Vol 26 (4) ◽  
pp. 490-495 ◽  
Author(s):  
Gabriele Testi ◽  
Tanja Ceccacci ◽  
Mauro Cevolani ◽  
Francesco Giacchi ◽  
Fabio Tarantino ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Balloon Catheter ◽  
Duplex Ultrasound ◽  
Cost Effective ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Anterior Tibial Artery ◽  
True Lumen ◽  
The Common

Purpose: To report a new technique to reenter the common femoral artery (CFA) true lumen after retrograde recanalization of a superficial femoral artery (SFA) with flush ostial occlusion. Technique: The technique is demonstrated in a 76-year-old woman with critical limb ischemia previously submitted to several surgical revascularizations. A duplex ultrasound showed flush ostial occlusion of the SFA and patency of the anterior tibial artery at the ankle as the sole outflow vessel. After unsuccessful antegrade attempts to recanalize the SFA, a retrograde guidewire was advanced subintimally up to the CFA, without gaining reentry. A balloon catheter was inflated in the subintimal plane across the SFA ostial occlusion. Antegrade access to the distal CFA was achieved with a 20-G needle, which was used to puncture the balloon. A guidewire was advanced into the balloon and pushed forward while the collapsed balloon was pulled back to the mid SFA. The antegrade guidewire was externalized through a retrograde catheter, which was pushed in the CFA true lumen. A retrograde guidewire was advanced and externalized through the femoral sheath, establishing a flossing wire. The procedure was completed in antegrade fashion. Conclusion: The FORLEE technique is a cost-effective option to gain the CFA true lumen after subintimal retrograde recanalization of an ostial SFA occlusion.

scholarly journals Ultrasound in diagnosis of anatomical variation of anterior and posterior tibial arteries.

2016 ◽  
Vol 18 (1) ◽  
pp. 64 ◽  
Author(s):  
Miao Zheng ◽  
Chuang Chen ◽  
Qianyi Qiu ◽  
Changjun Wu
Keyword(s):  
Anatomical Variation ◽  
Posterior Tibial Artery ◽  
Peroneal Artery ◽  
Medial Malleolus ◽  
Anterior Tibial Artery ◽  
Tarsal Tunnel ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Tibial Arteries ◽  
Anterior Tibial

Aims: Knowledge about branching pattern of the popliteal artery is very important in any clinical settings involving the anterior and posterior tibial arteries. This study aims to elucidate the anatomical variation patterns and common types of anterior tibial artery (ATA) and posterior tibial arteries (PTA) in the general population in China. Material and methods: Anatomical variations of ATA, PTA, and peroneal artery were evaluated with ultrasound in a total of 942 lower extremity arteries in 471 patients. Results: Three patterns of course in the PTA were ultrasonographically identified:  1) PTA1: normal anatomy with posterior tibial artery entering tarsal tunnel to perfuse the foot (91.5%),  2) PTA2: tibial artery agenetic, and replaced by communicating branches of peroneal artery entering tarsal tunnel above the medial malleolus to perfuse the foot (5.9%), and 3) PTA3: hypoplastic or aplastic posterior tibial artery communicating above the medial malleolus with thick branches of peroneal artery to form a common trunk entering into the tarsal tunnel (2.4%). In cases where ATA  was hypoplastic or aplastic, thick branches of the peroneal artery replaced the anterior tibial artery to give rise to dorsalis pedis artery, with a total incidence of 3.2 % in patients, and were observed more commonly in females than in males. Hypoplastic or aplastic termini of ATA and PTA, with perfusion of the foot solely by the peroneal artery, was identified in 1 case. In another case, both communicating branches of the peroneal artery and PTA entered the tarsal tunnel to form lateral and medial plantar arteries.Conclusions: Anatomical variation of ATA and PTA is relatively common in the normal population. Caution should be exercised with these variations when preparing a peroneal artery vascular pedicle flap grafting. Ultrasound evaluation provides accurate and reliable information on the variations.

scholarly journals Effects of Enhanced External Counterpulsation With Different Sequential Levels on Lower Extremity Hemodynamics

2021 ◽  
Vol 8 ◽  
Author(s):  
Yahui Zhang ◽  
Yujia Zhang ◽  
Yinfen Wang ◽  
Xiuli Xu ◽  
Jing Jin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Velocity ◽  
Posterior Tibial Artery ◽  
Anterior Tibial Artery ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Dorsalis Pedis Artery ◽  
Level Sequence ◽  
Anterior Tibial ◽  
Enhanced External Counterpulsation

Objective: This study aimed to investigate acute hemodynamics of lower extremities during enhanced external counterpulsation with a three-level sequence at the hips, thighs, and calves (EECP-3), two-level sequence at the hips and thighs (EECP-2), and single leg three-level sequence (EECP-1).Methods: Twenty healthy volunteers were recruited in this study to receive a 45-min EECP intervention. Blood flow spectrums in the anterior tibial artery, posterior tibial artery, and dorsalis pedis artery were imaged by Color Doppler ultrasound. Mean flow rate (FR), area, pulsatility index (PI), peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MV), and systolic maximum acceleration (CCAs) were sequentially measured and calculated at baseline during EECP-3, EECP-1, and EECP-2.Results: During EECP-3, PI, PSV, and MV in the anterior tibial artery were significantly higher, while EDV was markedly lower during EECP-1, EECP-2, and baseline (all P < 0.05). Additionally, ACCs were significantly elevated during EECP-3 compared with baseline. Moreover, FR in the anterior tibial artery was significantly increased during EECP-3 compared with baseline (P = 0.048). During EECP-2, PI and MV in the dorsalis pedis artery were significantly higher and lower than those at baseline, (both P < 0.05). In addition, FR was markedly reduced during EECP-2 compared with baseline (P = 0.028). During EECP-1, the area was significantly lower, while EDV was markedly higher in the posterior tibial artery than during EECP-1, EECP-2, and baseline (all P < 0.05). Meanwhile, FR of the posterior tibial artery was significantly reduced compared with baseline (P = 0.014).Conclusion: Enhanced external counterpulsation with three-level sequence (EECP-3), EECP-2, and EECP-1 induced different hemodynamic responses in the anterior tibial artery, dorsalis pedis artery, and posterior tibial artery, respectively. EECP-3 acutely improved the blood flow, blood flow velocity, and ACCs of the anterior tibial artery. In addition, EECP-1 and EECP-2 significantly increased the blood flow velocity and peripheral resistance of the inferior knee artery, whereas they markedly reduced blood flow in the posterior tibial artery.

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