Limits...
Endovascular sharp recanalization for calcified femoropopliteal artery occlusion.

Huang HL, Chou HH, Wu TY - Case Rep Cardiol (2012)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Section of Cardiology, Department of Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch, 289 Jiang Kuo Road, Xindian City, Taipei 23142, Taiwan.

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.

No MeSH data available.


Related in: MedlinePlus

(a) Total occlusion of the superficial femoral artery (SFA) from the ostium onwards, heavily calcified plaques, and filling of the middle and distal portions of the SFA by collaterals is shown (black arrows). (b) A huge calcified plaque (white arrows) is noted in the proximal portion of the SFA, and this plaque impedes lesion crossing. (c) The stiff end of the Terumo glidewire is used for sharp recanalization. (d) The middle portion of the SFA was observed using a contrast medium that was injected through the right Judkin catheter after sharp recanalization. (e) Stent implantation from the proximal to the distal portion of the SFA is successful, and good angiographic results are noted.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4008401&req=5

fig1: (a) Total occlusion of the superficial femoral artery (SFA) from the ostium onwards, heavily calcified plaques, and filling of the middle and distal portions of the SFA by collaterals is shown (black arrows). (b) A huge calcified plaque (white arrows) is noted in the proximal portion of the SFA, and this plaque impedes lesion crossing. (c) The stiff end of the Terumo glidewire is used for sharp recanalization. (d) The middle portion of the SFA was observed using a contrast medium that was injected through the right Judkin catheter after sharp recanalization. (e) Stent implantation from the proximal to the distal portion of the SFA is successful, and good angiographic results are noted.

Mentions: A 67-year-old woman with a medical history of hypertension, end-stage renal disease, and left femoropopliteal artery bypass that was performed 3 years ago was referred to our institute for EVI because of gangrene of the left second toe and intractable pain. The ankle brachial index (ABI) was low at 0.35. The extremity of angiography revealed occlusion of the left superficial femoral artery (SFA) from its ostium with collaterals supplying the distal portion of the SFA and tibial arteries (Figure 1(a)). EVI was performed via the ipsilateral antegrade femoral approach. A 6-Fr introducer sheath (Radifocus Introducer II, Terumo, Tokyo, Japan) was placed in the artery after successful antegrade arterial puncture. 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. This is because a calcified hard 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)). The occluded lumen of the arterial portion distal to this plaque was visualized by using a contrast medium that was injected via the JR catheter (Figure 1(d)). A 300 cm long PT2 guidewire (Boston Scientific) was used to cross the lesion, and subsequently, angioplasty was performed. Two long Edwards Self-Expanding Lifestents (Bard, Edwards Lifesciences, Irvine, CA, USA) were deployed consecutively from the proximal to the distal portion of the SFA, and good angiographic results were obtained (Figure 1(e)). After the intervention, the ischemic symptoms resolved, and the ABI increased to 0.78. The patient's second toe was amputated 1 month after the intervention. Repeat intervention was performed 7 months after the index procedure because an additional lesion in the left common iliac artery and diffuse in-stent restenosis at the site of stent placement in the SFA were noted. The patient's condition was stable after the second intervention, and ischemic symptoms had disappeared.


Endovascular sharp recanalization for calcified femoropopliteal artery occlusion.

Huang HL, Chou HH, Wu TY - Case Rep Cardiol (2012)

(a) Total occlusion of the superficial femoral artery (SFA) from the ostium onwards, heavily calcified plaques, and filling of the middle and distal portions of the SFA by collaterals is shown (black arrows). (b) A huge calcified plaque (white arrows) is noted in the proximal portion of the SFA, and this plaque impedes lesion crossing. (c) The stiff end of the Terumo glidewire is used for sharp recanalization. (d) The middle portion of the SFA was observed using a contrast medium that was injected through the right Judkin catheter after sharp recanalization. (e) Stent implantation from the proximal to the distal portion of the SFA is successful, and good angiographic results are noted.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4008401&req=5

fig1: (a) Total occlusion of the superficial femoral artery (SFA) from the ostium onwards, heavily calcified plaques, and filling of the middle and distal portions of the SFA by collaterals is shown (black arrows). (b) A huge calcified plaque (white arrows) is noted in the proximal portion of the SFA, and this plaque impedes lesion crossing. (c) The stiff end of the Terumo glidewire is used for sharp recanalization. (d) The middle portion of the SFA was observed using a contrast medium that was injected through the right Judkin catheter after sharp recanalization. (e) Stent implantation from the proximal to the distal portion of the SFA is successful, and good angiographic results are noted.
Mentions: A 67-year-old woman with a medical history of hypertension, end-stage renal disease, and left femoropopliteal artery bypass that was performed 3 years ago was referred to our institute for EVI because of gangrene of the left second toe and intractable pain. The ankle brachial index (ABI) was low at 0.35. The extremity of angiography revealed occlusion of the left superficial femoral artery (SFA) from its ostium with collaterals supplying the distal portion of the SFA and tibial arteries (Figure 1(a)). EVI was performed via the ipsilateral antegrade femoral approach. A 6-Fr introducer sheath (Radifocus Introducer II, Terumo, Tokyo, Japan) was placed in the artery after successful antegrade arterial puncture. 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. This is because a calcified hard 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)). The occluded lumen of the arterial portion distal to this plaque was visualized by using a contrast medium that was injected via the JR catheter (Figure 1(d)). A 300 cm long PT2 guidewire (Boston Scientific) was used to cross the lesion, and subsequently, angioplasty was performed. Two long Edwards Self-Expanding Lifestents (Bard, Edwards Lifesciences, Irvine, CA, USA) were deployed consecutively from the proximal to the distal portion of the SFA, and good angiographic results were obtained (Figure 1(e)). After the intervention, the ischemic symptoms resolved, and the ABI increased to 0.78. The patient's second toe was amputated 1 month after the intervention. Repeat intervention was performed 7 months after the index procedure because an additional lesion in the left common iliac artery and diffuse in-stent restenosis at the site of stent placement in the SFA were noted. The patient's condition was stable after the second intervention, and ischemic symptoms had disappeared.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Section of Cardiology, Department of Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch, 289 Jiang Kuo Road, Xindian City, Taipei 23142, Taiwan.

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.

No MeSH data available.


Related in: MedlinePlus