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 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.

scholarly journals The “Direct tip injection in occlusive lesions (DIOL)” fashion

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Takuya Haraguchi ◽  
Tsutomu Fujita ◽  
Yoshifumi Kashima ◽  
Masanaga Tsujimoto ◽  
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.

Vibrational Angioplasty in the Treatment of Chronic Infrapopliteal Arterial Occlusions: Preliminary Experience

2002 ◽  
Vol 9 (6) ◽  
pp. 889-895 ◽  
Author(s):  
Dimitrios K. Tsetis ◽  
Lampros K. Michalis ◽  
Michael R. Rees ◽  
Asterios N. Katsamouris ◽  
Miltiadis I. Matsagas ◽  
...  
Keyword(s):  
Posterior Tibial Artery ◽  
Peroneal Artery ◽  
Anterior Tibial Artery ◽  
Long Term Effects ◽  
Chronic Total Occlusions ◽  
Tibial Artery ◽  
Anterior Tibial ◽  
Short And Long Term ◽  
The Wire ◽  
Infrapopliteal Arteries

Purpose: To evaluate the safety and efficacy of vibrational angioplasty in chronic infrapopliteal arterial occlusions. Methods: Twelve patients (9 men, aged 54 to 90 years) with 13 below-knee arterial chronic total occlusions were treated percutaneously using vibrational angioplasty. The occlusions were located in the anterior tibial artery (n=5), the tibioperoneal trunk (n=4), the peroneal artery (n=1), the posterior tibial artery (n=1), and in both the tibioperoneal trunk and peroneal artery (n=2). The length of the lesions ranged from 5 to 14 cm. Results: Recanalization was successful in 12 (92.3%) lesions. In 1 case, the wire perforated the arterial wall; the procedure was abandoned without clinical sequelae. The time to cross the occlusions with the wire ranged from 6 to 19 minutes. No other complications were observed. Clinical follow-up ranged to 18 months. Ten patients with ulceration or gangrene demonstrated good wound healing, and pain was alleviated in all successfully treated patients. Conclusions: Vibrational angioplasty appears feasible as a means of safely recanalizing chronic total occlusions of the infrapopliteal arteries. Further experience should be acquired to assess its short- and long-term effects on this vascular territory.

Influence of diabetes on diagnostic performance of computed tomography angiography of the calf arteries in acute limb ischemia

2021 ◽  
pp. 028418512110069
Author(s):  
Talha Butt ◽  
Leena Lehti ◽  
Jan Apelqvist ◽  
Anders Gottsäter ◽  
Stefan Acosta
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Diagnostic Performance ◽  
Intraclass Correlation ◽  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Acute Limb Ischemia ◽  
Below The Knee

Background Patients with diabetes mellitus (DM) have a more extensive distal arterial occlusive disease compared to non-diabetic patients. Diagnostic imaging is a necessity to identify the location and extent of the arterial occlusion in acute limb ischemia (ALI). Computed tomography angiography (CTA) is the most commonly used modality and the diagnostic performance with CTA of calf arteries may be questioned. Purpose To evaluate diagnostic performance of CTA of calf arteries in ALI and to compare patients with and without DM. Material and Methods All thrombolytic treatments performed during 2001–2008 in patients with ALI were included. Initial digital subtraction angiography (DSA) and CTA of all patients were classified according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) below-the-knee arteries and compared to CTA. Two raters assessed the CTA images independently. Inter-rater reliability was expressed as intraclass correlation (ICC) with 95% confidence intervals (CI). Results Patients with (n = 23) and without (n = 85) DM had lower ( P = 0.006) glomerular filtration rate. ICC between CTA and DSA was 0.33 (95% CI –0.22 to 0.56) and 0.71 (95% CI 0.38–0.68) in patients with and without DM, respectively. Sensitivity with CTA for TASC D lesions in patients with and without DM was 0.14 (95% CI –0.12 to 0.40) and 0.64 (95% CI 0.48–0.80), respectively. Conclusion The sensitivity of CTA for assessment of infra-popliteal TASC D lesions in patients with ALI was not acceptable in patients with DM in contrast to those without DM. Another imaging option at present times should be considered for patients with DM.

scholarly journals The wire loop technique for IVC filter removal

2021 ◽  
Author(s):  
Cassius Iyad Ochoa Chaar ◽  
Valentyna Kostiuk ◽  
Navid Gholitabar
Keyword(s):  
Ivc Filter ◽  
Wire Loop ◽  
Loop Technique ◽  
The Wire

Initial Clinical Experience with Percutaneous Atherectomy in the Infragenicular Arteries

2003 ◽  
Vol 10 (5) ◽  
pp. 987-993 ◽  
Author(s):  
Thomas Zeller ◽  
Ulrich Frank ◽  
Karlheinz Bürgelin ◽  
Uwe Schwarzwälder ◽  
Peter-Christian Flügel ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Ankle Brachial Index ◽  
Peroneal Artery ◽  
Lesion Length ◽  
Anterior Tibial Artery ◽  
Tibial Artery ◽  
Below The Knee ◽  
Directional Atherectomy ◽  
Mean Diameter ◽  
The Mean

Purpose: To evaluate the efficacy and safety of a new atherectomy device for the treatment of infragenicular lesions in arteries with a reference diameter of at least 2.5 mm. Methods: Twenty-seven below-the-knee lesions in 17 patients (12 men; mean age 69±12 years) with chronic peripheral arterial occlusive disease were treated with directional atherectomy. The target lesion was in the popliteal artery (segment 3) in 2 (7%) cases, the tibioperoneal trunk in 12 (44%), the peroneal artery in 8 (30%), the anterior tibial artery in 2 (7%), and the posterior tibial artery in 3 (11%). Six (22%) of the lesions were in-stent stenoses. The mean diameter stenosis was 87%±9%, and the mean lesion length was 34±24 mm. Results: All but 2 (7%) of the lesions could be treated successfully (residual stenosis <30%) with the atherectomy catheter (93% technical success) using an average of 5±2 (range 1–10) passes of the device. Six lesions (22%) were treated after predilation and 21 (78%) with primary atherectomy. In 8 (30%) lesions, additional balloon angioplasty was performed. The 2 failures were in heavily calcified lesions through which the device could not pass despite predilation. The mean diameter stenosis after atherectomy was 14%±22% (range 0%–90%); after additional balloon angioplasty, the mean residual stenoses reduced to 12%±21% (range 0%–100%). One (6%) of the 2 patients who failed atherectomy sustained a thrombotic occlusion of the target vessel. This complication was treated successfully with local lysis, but the vessel reoccluded 3 days later; a stent was implanted. The mean ankle-brachial index increased from 0.50±0.27 to 0.86±0.40 before discharge. Conclusions: Below-the-knee native vessel lesions and in-stent restenoses with a diameter of at least 2.5 mm can be treated successfully and safely with this new atherectomy catheter. Additional balloon angioplasty was necessary in only a few cases.

Extravascular Recanalization of Chronic Total Occlusions

2018 ◽  
Author(s):  
S. Lowell Kahn
Keyword(s):  
Lower Extremity ◽  
Success Rate ◽  
Technical Failure ◽  
Technical Success ◽  
Contrast Injection ◽  
True Lumen ◽  
Chronic Total Occlusions ◽  
Technical Success Rate ◽  
The Wire

Subintimal revascularization is a mainstay of therapy for lower extremity interventions. This stems from the realization that true lumen traversal is not always possible, subintimal revascularization has a high technical success rate, and the subintimal space may confer advantages over a heavily calcified true lumen. Most commonly in the tibial vasculature, there are times when subintimal recanalization is not possible because the wire and catheter may leave the subintimal plane and enter the periadventitial tissue. Although this is not intentional, exit from the vessel historically results in a technical failure because future passes of the wire and catheter are likely to follow suit, as evidenced by extravasation on contrast injection. This chapter describes two techniques to salvage this scenario and accept an extravascular tract for revascularization: the Outback® extravascular revascularization technique and the percutaneous gun-sight extravascular revascularization technique.

Sign in / Sign up

Export Citation Format

Share Document