Successful re-entry using the outback\xae elite catheter via retrograde popliteal access with IVUS guidance for femoropopliteal occlusion: a case report

Naoki Hayakawa,Masataka Arakawa,Satoshi Kodera,Junji Kanda

doi:10.1186/s42155-020-00156-9

Naoki Hayakawa, Masataka Arakawa + Show 2 more

Open Access

https://doi.org/10.1186/s42155-020-00156-9

Copy DOI

Journal: CVIR Endovascular	Publication Date: Sep 5, 2020
Citations: 5	License type: open-access

Affiliation: Asahi Hospital, University of Tokyo Hospital

Abstract

BackgroundThere are still cases that are difficult to treat for femoropopliteal chronic total occlusion (CTO). The Outback® Elite catheter is effective re-entry device to treat such kind of difficult cases, however, it might be difficult to use the Outback® Elite catheter antegradely in cases with severely calcified lesions. In this case, we performed EVT using the Outback Elite® catheter via the retrograde popliteal approach.Case presentationWe report a case of a 77-year-old male with end-stage renal disease who presented with pain and cyanosis of his left foot. Control angiography showed total occlusion from the middle of the left superficial femoral artery to the proximal portion of the popliteal artery. The CTO lesion was severely calcified, which prevented the antegrade advancement of any guidewire. Retrograde popliteal puncture was performed with the patient in the supine position. After intentional retrograde subintimal wiring, the Outback® Elite catheter was advanced via the retrograde approach after the identification of a suitable re-entry site using intravascular ultrasound. After wire crossing, one nitinol stent was deployed and sufficient antegrade flow was achieved without any complications.ConclusionsUsing Outback® Elite from retrograde should be considered in cases where antegrade advancement fails and bidirectional wiring cannot pass through the CTO lesion.

Highlights

There are still cases that are difficult to treat for femoropopliteal chronic total occlusion (CTO)
Using Outback® Elite from retrograde should be considered in cases where antegrade advancement fails and bidirectional wiring cannot pass through the CTO lesion
We report a case in which superficial femoral artery (SFA) CTO with severe calcification was successfully recanalized via the use of intravascular ultrasound (IVUS) to identify a portion with relatively little calcification at which retrograde reentry with the Outback® Elite catheter was possible

Summary

Background

The success rate of endovascular treatment (EVT) for chronic total occlusion (CTO) of the superficial femoral artery (SFA) has improved due to the development of reentry devices and CTO crossing devices and the retrograde approach (Schneider 2017; Soga et al 2018; Schmidt et al 2012). We report a case in which SFA CTO with severe calcification was successfully recanalized via the use of intravascular ultrasound (IVUS) to identify a portion with relatively little calcification at which retrograde reentry with the Outback® Elite catheter was possible. Jupiter T45® guidewire with a 45 g tapered wire tip (Boston Scientific) inside the CTO, but its progress was hindered by severe calcification and it could not be advanced beyond the distal SFA (Fig. 2a). IVUS showed that the retrograde wire was in the subintimal space and that the vessel walls were hardened by severe calcification, suggesting that the CTO lesion would be extremely difficult to negotiate with a guidewire or the controlled antegrade and retrograde subintimal tracking (CART) technique. An attempt to pass a hard guidewire through the lesion

Discussion

Conclusions