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

• 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
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481908500902

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.