Treatment of an external iliac artery chronic total occlusion using alternate access sites

Justin Ratcliffe,Joseph Puma,Philip Green,Mike Gorenchtein,Pankaj Khullar,Abel Casso Dominguez,Mohan Satish

doi:10.1186/s42155-019-0089-6

Abstract

BackgroundWith the advent of endovascular techniques, alternate sites such as the pedal and radial arteries can now be accessed when treating peripheral arterial disease to reduce procedural complications, shorten recovery time, and improve patient comfort. However, a paucity of literature exists on the availability of support devices that can be utilized during challenging cases.Case presentationA 70 year-old female patient presented for evaluation of severe lifestyle-limiting left-sided claudication refractory to maximal medical therapy. Angiography revealed a chronic total occlusion of the left external iliac artery, which was treated successfully by percutaneous intervention via a primary transpedal approach and with the assistance of the Outback® Elite re-entry device. The patient was discharged 2 h after the procedure and reported significant symptom improvement at follow-up.ConclusionThis case highlights a newly adopted endovascular approach through an alternate access site and illustrates how the Outback® Elite device can be used as an adjunctive tool in the treatment of complex lower-extremity vascular lesions.

Highlights

With the advent of endovascular techniques, alternate sites such as the pedal and radial arteries can be accessed when treating peripheral arterial disease to reduce procedural complications, shorten recovery time, and improve patient comfort
This case highlights a newly adopted endovascular approach through an alternate access site and illustrates how the Outback® Elite device can be used as an adjunctive tool in the treatment of complex lowerextremity vascular lesions
Recent studies have demonstrated the safety and procedural success of retrograde below-the-knee punctures, including the subintimal arterial flossing with anterograde-retrograde intervention (SAFARI) and the controlled antegrade retrograde reentry technique (CART)

Summary

Conclusion

This case report demonstrates the treatment of an external iliac artery CTO via the transpedal approach with the aid of the Outback® Elite Re-Entry Device.

Background

Discussion