Abstract
IntroductionRecanalization in an antegrade fashion in complex infrainguinal arterial disease can prove challenging and use of the Outback re-entry device via a retrograde approach may be an option.Case presentationUsing an antegrade approach we were unable to cross the native occluded superficial femoral artery in a patient after two occluded bypasses, with ulcers and was unfit for general anaesthesia.We successfully attempted retrograde re-entry using an Outback device via a phantom segment of the anterior tibial artery. After angioplasty and stenting a satisfactory result was achieved with one artery runoff.ConclusionsAt the 24 months follow up reconstruction was patent and ulcers were healed after 4 months.The outcome of more cases will be decisive for the broader applicability of this technique.
Highlights
Recanalization in an antegrade fashion in complex infrainguinal arterial disease can prove challenging and use of the Outback re-entry device via a retrograde approach may be an option
Despite the limitations of the Outback device (Shin et al 2011) it is frequently used for infrainguinal re-entry and is even used to re-enter true lumen of below-the-knee vessels (Diamantopoulos et al 2018; Kitrou et al 2015)
We present a case of retrograde recanalization of the anterior tibial artery, popliteal artery and superficial femoral artery with retrograde re-entry via the short superficial
Summary
Recanalization in an antegrade fashion in complex infrainguinal arterial disease can prove challenging and use of the Outback re-entry device via a retrograde approach may be an option. Despite the limitations of the Outback device (Shin et al 2011) it is frequently used for infrainguinal re-entry (with reported success 65–100%) and is even used to re-enter true lumen of below-the-knee vessels (Diamantopoulos et al 2018; Kitrou et al 2015). The Outback device has proved useful in chronic and even calcific lesions of the superficial femoral artery (Gandini et al 2013).
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