Abstract
Patients with critical limbs ischemia received endovascular revascularization for his posterior tibial artery (PTA) to plantar artery long occlusion without proximal stump. Antegrade recanalization seemed impossible, so retrograde access should be considered. However, the conventional retrograde puncture was also not available. Therefore, novel retrograde transplantar access was conducted. The plantar artery was successfully punctured with a 20-G needle. In addition, a guidewire was retrogradely inserted with a sheathless technique. Finally, it was retrogradely crossed the occluded lesion. The final angiogram showed sufficient results. Transplantar retrograde access was feasible technique for infrapopliteal EVT, when the conventional antegrade and retrograde approaches were not available.
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References
Wolfe JH, Wyatt MG. Critical and subcritical ischaemia. Eur J Vasc Endovasc Surg. 1997;13:578–82.
Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(suppl S):S5–67.
Organisation European Stroke, Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the task force on the diagnosis and treatment of peripheral artery diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2851–906.
Iida O, Soga Y, Hirano K, et al. Midterm outcomes and risk stratification after endovascular therapy for patients with critical limb ischaemia due to isolated below-the-knee lesions. Eur J Vasc Endovasc Surg. 2012;43:313–21.
Ferraresi R, Palena LM, Mauri G, et al. Tips and tricks for a correct “endo approach”. J Cardiovasc Surg (Trino). 2013;54:685–711.
Fusaro M, Agostoni P, Biondi-Zoccai G. “Trans-collateral” angioplasty for a challenging chronic total occlusion of the tibial vessels: a novel approach to percutaneous revascularization in critical limb ischemia. Catheter Cardiovasc Interv. 2008;71(2):268–72.
Shimada Y, Kino N, Tonomura D, et al. Transcollateral retrograde approach with rendezvous technique for recanalization of chronically occluded tibial arteries. J Endovasc Ther. 2012;19:620–6.
Nakama T, Shibata Y, Ogata K, et al. An extreme recanalization: transcollateral retrograde wiring for below-the-ankle occlusive lesion. EJEVS Extra. 2014;27:e7–9.
Kawarada O, Sakamoto S, Harada K, et al. Contemporary crossing techniques for infrapopliteal chronic total occlusions. J Endovasc Ther. 2014;21:266–80.
Manzi M, Palena LM. Retrograde percutaneous transmetatarsal artery access: new approach for extreme revascularization in challenging case of critical limb ischemia. Cardiovasc Intervent Radiol. 2013;36:554–7.
Palena LM, Manzi M. Extreme below-the-knee interventions: retrograde transmetatarsal or transplantar arch access for foot salvage in challenging cases of critical limb ischemia. J Endovasc Ther. 2012;19:805–11.
Palena LM, Brocco E, Manzi M. The clinical utility of below-the-ankle angioplasty using “transmetatarsal artery access” in complex cases of CLI. Catheter Cardiovasc Interv. 2014;83:123–9.
Iida O, Soga Y, Kawasaki D, et al. Angiographic restenosis and its clinical impact after infrapopliteal angioplasty. Eur J Vasc Endovasc Surg. 2012;44:425–31.
Tsuchikane E, Katoh O, Kimura M, et al. The first clinical experience with a novel catheter for collateral channel tracking in retrograde approach for chronic coronary total occlusions. JACC Cardiovasc Interv. 2010;2:165–71.
Surmely JF, Tsuchikane E, Katoh O, et al. New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: CART technique. J Invasive Cardiol. 2006;18:334–8.
Kimura M, Katoh O, Tsuchikane E, et al. The efficacy of a bilateral approach for treating lesions with chronic total occlusions the CART (controlled antegrade and retrograde subintimal tracking) registry. JACC Cardiovasc Inerv. 2009;11:1135–41.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Nakama, T., Ando, H., Watanabe, N. et al. Novel retrograde puncture technique for infrapopliteal artery revascularization: transplantar retrograde access. Cardiovasc Interv and Ther 32, 287–293 (2017). https://doi.org/10.1007/s12928-016-0422-0
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DOI: https://doi.org/10.1007/s12928-016-0422-0