“Trans-collateral” angioplasty for a challenging chronic total occlusion of the tibial vessels: A novel approach to percutaneous revascularization in critical lower limb ischemia
✍ Scribed by Massimiliano Fusaro; Pierfrancesco Agostoni; Giuseppe Biondi-Zoccai
- Publisher
- John Wiley and Sons
- Year
- 2008
- Tongue
- English
- Weight
- 274 KB
- Volume
- 71
- Category
- Article
- ISSN
- 1522-1946
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✦ Synopsis
Abstract
Arterial revascularization by means of percutaneous transluminal angioplasty (PTA) is a mainstay in the management of patients with peripheral artery disease and critical limb ischemia (CLI). However, when employing standard approaches, PTA of below‐the‐knee arteries may fail in up to 20% of cases. In the present article, we report a novel interventional strategy, the “transcollateral” angioplasty approach, which we successfully employed in a patient with critical lower limb ischemia and a challenging total infrapopliteal occlusion. This technique may probably increase success rates of PTA in very challenging total occlusions of below‐the‐knee arteries (e.g., those lacking a proximal occlusion stump). The tips pertinent to this case are illustrated, including the need to accurately choose appropriate guidewires and balloons, and the identification of the most appropriate collateral pathway. © 2008 Wiley‐Liss, Inc.