Antegrade Pedal Approach for Recanalizing Occlusions in the Opposing Circulatory Pathway of the Foot When a Retrograde Puncture is Not Possible

• Published in: Journal of endovascular therapy Vol. 21; no. 6; pp. 775 - 778
• Main Authors: Palena, Luis Mariano, Manzi, Marco
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-12-2014; Allen Press Inc
• Subjects: Amputation; Angioplasty - adverse effects; Angioplasty - methods; Catheters; Chronic Disease; Foot - blood supply; Humans; Ischemia; Limb Salvage; Mortality; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - physiopathology; Peripheral Arterial Disease - therapy; Punctures; Regional Blood Flow; Treatment Outcome; Vascular Patency; limb salvage; amputation; plantar artery; recanalization; below-the-knee angioplasty; critical limb ischemia; below-the-ankle vessels; pedal artery; chronic total occlusion; antegrade approach; tibial artery; diabetes; angioplasty
• ISSN: 1526-6028; 1545-1550
• DOI: 10.1583/14-4801R.1

Purpose:
To describe a novel technical strategy to approach below-the-ankle chronic total occlusions after failed antegrade recanalization in patients who are not candidates for retrograde puncture.
Technique:
After a failure of antegrade recanalization of the tibial and foot vessels, an antegrade pedal access can be performed in the pedal or plantar artery. After crossing the plantar arch and the occlusions in the opposing circulation pathway of the foot, a rendezvous with the antegrade catheter is performed, followed by final angioplasty and hemostasis.
Conclusion:
An antegrade pedal approach to the opposing circulation in the foot may be considered for below-the-ankle recanalization after standard antegrade recanalization failure in patients who are not candidates for a retrograde puncture.