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

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.

A case report of entrapped angioplasty balloon in circumflex coronary artery

Entrapment of coronary angioplasty hardware during coronary artery interventions is rare but in most cases requires prompt treatment. This article reported a case of 65-year-old woman who underwent a percutaneous transluminal coronary angioplasty to the circumflex artery. A ruptured angioplasty balloon was entrapped in the circumflex artery with proximal end of the guidewire placed in the descending aorta. The patient underwent surgical removal of the foreign body and coronary artery bypass grafting. The case and the management are discussed. Keywords: Angioplasty; coronary artery bypass; equipment failure; angioplasty balloon.

Entrapment of fractured balloon after angioplasty in an AV access using a covered stent

Fracture of the angioplasty balloon is a known complication during endovascular procedures in arteriovenous (AV) fistulas and grafts. We describe a case of a patient with end-stage renal disease (ESRD) on dialysis with a brachiocephalic AV fistula that had become dysfunctional. After a percutaneous angioplasty procedure during balloon withdrawal, a portion of the balloon fractured and separated due to the balloon being caught in the struts of a previously placed bare metal stent. A covered stent was used to contain the segment of the fractured balloon to the wall of the fistula. The use of a covered stent in jailing the fractured balloon to prevent further complications is not well described. This strategy may be implemented in some circumstances such as this case to avoid surgical interventions.