Endovascular sharp recanalization for calcified femoropopliteal artery occlusion.

Hsuan-Li Huang,Hsin-Hua Chou,Tien-Yu Wu

doi:10.1155/2012/516027

Hsuan-Li Huang, Hsin-Hua Chou + Show 1 more

Open Access

https://doi.org/10.1155/2012/516027

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Journal: Case reports in cardiology	Publication Date: Jan 1, 2012
Citations: 12	License type: CC BY 3.0

Affiliation: Buddhist Tzu Chi General Hospital

Abstract

Endovascular intervention of peripheral chronic total occlusion (CTO) is technically challenging and time consuming. Various techniques and devices are used to facilitate lesion crossing and improve the success rate of the procedure. However, these new devices are quite expensive and not readily available. We report 2 cases of peripheral CTO wherein the occlusions were successfully crossed by using stiff end of Terumo glidewire. This sharp recanalization may be a useful technique for the recanalization of calcified peripheral CTOs when conventional techniques fail and new devices are not readily available, but it is accompanied by the risk of distal atheroembolism.

Highlights

Percutaneous endovascular techniques have revolutionized the management of symptomatic peripheral arterial occlusive disease (PAOD) when conservative medical treatment fails; patients who undergo treatment using these techniques have lower morbidity and recover earlier than patients treated by surgical bypass [2]
Peripheral chronic total occlusion (CTO) commonly occur in patients with limb ischemia, and recanalization of these occlusions is technically challenging and timeconsuming
New devices and techniques are used for facilitating the recanalization of peripheral CTOs, including reentry catheters [5, 6], blunt microdissection catheters [7], optical coherence reflectometry, excimer laser, and ultrasoundguided vibration angioplasty [8]

Summary

Introduction

Lesion crossing was unsuccessful when conventional techniques were applied using 0.014-in Conquest pro CTO guidewire (Asahi Intec, Aichi, Japan), 0.018-in V18-control wire (Boston Scientific, Natick, MA, USA), or 0.035-in Terumo stiff glidewire (Radifocus, Terumo, Tokyo, Japan) along with the balloon or exchange catheter. Case Reports in Cardiology (a) plaque present in the proximal-middle region of the SFA blocked the reentry into the true lumen during subintimal angioplasty (Figure 1(b)). The plaque was carefully probed and penetrated using the stiff end of the Terumo glidewire that was supported by a 5-Fr right Judkins (JR) catheter (Figure 1(c)).

Results

Conclusion