Transpedal Laser Atherectomy via a Communicating Branch to Treat Tibial Artery Chronic Total Occlusions

Furthermore, transpedal access has emerged as a powerful tool in the treatment of tibial occlusive lesions when antegrade endovascular techniques fail and open intervention is too high risk.3 The transpedal route enables endovascular access in patients with limited femoral access options in the sett...

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Bibliographic Details
Published in:The American surgeon 2019-09, Vol.85 (9), p.436-438
Main Authors: Sahajwani, Sunny, Orbay, Hakan, Santini, Rafeal, Ucuzian, Areck, Nagarsheth, Khanjan
Format: Article
Language:English
Subjects:
Anesthesia
Angioplasty
Aorta
Bifurcations
Bleeding
Blood vessels
Cardiovascular system
Catheters
Complications
Femur
Fistulae
Hematoma
Intervention
Ischemia
New technology
Occlusion
Patients
Pseudoaneurysm
Risk communication
Sheaths
Ultrasonic imaging
Vascular surgery
Wound healing
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Summary:Furthermore, transpedal access has emerged as a powerful tool in the treatment of tibial occlusive lesions when antegrade endovascular techniques fail and open intervention is too high risk.3 The transpedal route enables endovascular access in patients with limited femoral access options in the setting of severe ipsilateral or contralateral proximal disease, unfavorable aortic bifurcation anatomy, and large body habitus. Pedal access also decreases the risk of complications associated with femoral access, including retroperitoneal bleed, hematoma, pseudoaneurysm, and arteriovenous fistula.1 The technical success rates of recanalization in case of chronic total occlusion improved more than 90 per cent with the use of transpedal access. Slender 5-Fr sheaths can be used that have an inner 5-Fr diameter with the outer diameter of a 4-Fr sheath.4 With this sheath size, the number of endovascular techniques is enhanced similar to what is available from an antegrade approach atherectomy of tibial vessels is seldom performed; however, we have shown that endothelial remodeling techniques typically reserved for infrapopliteal disease can be safely and successfully performed when the advances in technique are combined with new technology. [...]with increasing experience using transpedal access, we have shown that it is possible to recanalize target vessels through communicating branches when that is the only option.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313481908500902