PMID- 36988702
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230401
IS  - 2520-8934 (Electronic)
IS  - 2520-8934 (Linking)
VI  - 6
IP  - 1
DP  - 2023 Mar 29
TI  - Inframalleolar thrice distal puncture in a single endovascular treatment session 
      for successful revascularization.
PG  - 20
LID - 10.1186/s42155-023-00369-8 [doi]
LID - 20
AB  - BACKGROUND: Most patients with chronic limb-threatening ischemia (CLTI) have 
      infrapopliteal arterial disease, which are often challenging to treat. In 
      endovascular treatment (EVT) for these complex lesions, establishing retrograde 
      access is an essential option not only for guidewire crossing but also for device 
      delivery. However, no EVT case has yet been reported requiring inframalleolar 
      thrice distal puncture in a single EVT session so far. CASE PRESENTATION: A 
      60-year-old CLTI patient with grade 3 Wound, Ischemia and foot Infection (WIfI) 
      classification underwent EVT for occluded dorsal artery and posterior tibial 
      artery. First, we conducted successful balloon angioplasty of the posterior 
      tibial artery by establishing a retrograde approach via the lateral plantar 
      artery. To treat the occlusion of the dorsal artery, we punctured the first 
      dorsal metatarsal artery, and retrogradely advanced a guidewire to the dorsal 
      artery occlusion; however, the microcatheter could not follow the guidewire. 
      Therefore, we punctured the occluded distal anterior tibial artery and introduced 
      the retrograde guidewire into the puncture needle. After guidewire 
      externalization, we pulled up the retrograde microcatheter into the occlusion of 
      dorsal artery using the "balloon deployment using forcible manner" technique. 
      Thereafter, we were able to advance the antegrade guidewire into the retrograde 
      microcatheter. After guidewire externalization, an antegrade balloon catheter was 
      delivered and inflated for the purpose of dorsal artery dilation and hemostasis 
      at the "needle rendezvous" point. Consecutively, balloon dilation was performed 
      for puncture site hemostasis of the first dorsal metatarsal artery and complete 
      hemostasis was achieved. Finally, we confirmed good vascular patency and 
      favorable blood flow. After revascularization, transmetatarsal amputation was 
      performed and the wound healed favorably. CONCLUSIONS: We can markedly increase 
      the success rate of revascularization by effectively utilizing the retrograde 
      approach in EVT for complex chronic total occlusions in infrapopliteal arterial 
      diseases.
CI  - (c) 2023. The Author(s).
FAU - Ota, Issei
AU  - Ota I
AD  - Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, 25, Yagi-Ueno, 
      Yagi-cho, Nantan City, Kyoto, 629-0197, Japan.
FAU - Nomura, Tetsuya
AU  - Nomura T
AUID- ORCID: 0000-0001-6556-9052
AD  - Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, 25, Yagi-Ueno, 
      Yagi-cho, Nantan City, Kyoto, 629-0197, Japan. t2ya821@yahoo.co.jp.
FAU - Ono, Kenshi
AU  - Ono K
AD  - Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, 25, Yagi-Ueno, 
      Yagi-cho, Nantan City, Kyoto, 629-0197, Japan.
FAU - Sakaue, Yu
AU  - Sakaue Y
AD  - Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, 25, Yagi-Ueno, 
      Yagi-cho, Nantan City, Kyoto, 629-0197, Japan.
FAU - Shoji, Keisuke
AU  - Shoji K
AD  - Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, 25, Yagi-Ueno, 
      Yagi-cho, Nantan City, Kyoto, 629-0197, Japan.
FAU - Wada, Naotoshi
AU  - Wada N
AD  - Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, 25, Yagi-Ueno, 
      Yagi-cho, Nantan City, Kyoto, 629-0197, Japan.
LA  - eng
PT  - Journal Article
DEP - 20230329
PL  - Switzerland
TA  - CVIR Endovasc
JT  - CVIR endovascular
JID - 101738484
PMC - PMC10060607
OTO - NOTNLM
OT  - Critical limb-threatening ischemia
OT  - Distal puncture
OT  - Endovascular treatment
OT  - Inframalleolar
OT  - Infrapopliteal arterial disease
COIS- The authors declare that they have no competing interests.
EDAT- 2023/03/30 06:00
MHDA- 2023/03/30 06:01
PMCR- 2023/03/29
CRDT- 2023/03/29 11:16
PHST- 2023/01/07 00:00 [received]
PHST- 2023/03/18 00:00 [accepted]
PHST- 2023/03/30 06:01 [medline]
PHST- 2023/03/29 11:16 [entrez]
PHST- 2023/03/30 06:00 [pubmed]
PHST- 2023/03/29 00:00 [pmc-release]
AID - 10.1186/s42155-023-00369-8 [pii]
AID - 369 [pii]
AID - 10.1186/s42155-023-00369-8 [doi]
PST - epublish
SO  - CVIR Endovasc. 2023 Mar 29;6(1):20. doi: 10.1186/s42155-023-00369-8.