PMC6410380_01
Pre-intervention baseline outflow anatomy visualized from above (A) and from a retrograde injection via pedal access (B). Arrow in (A) shows severe right tibioperoneal disease. Arrow in (B) shows occlusion of the right posterior tibialis above the ankle.
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A 150 cm glide catheter (Terumo) was then placed over the 400 cm wire and advanced to the right PF where an injection of contrast was performed to visualize the reconstitution of the right SFA and outflow vessels distally by collaterals (Figure 1).
(A) Antegrade angiogram from catheter using a radial access (dark arrow) showing the occluded right superficial femoral artery at its origin and the patent profunda femoris artery. Catheter and wire from the retrograde pedal approach is also shown (white arrow) and wire is subintimal into the right femoral artery. (B) Wire and catheter crossing the proximal SFA antegradely (dark arrow). The position of the origin of the SFA has been facilitated by the presence of a catheter and wire close to the origin from the retrograde approach. (C) Final treatment of the SFA and CFA with excellent results.
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The angled 150 cm NaviCross catheter (Terumo) was advanced from the pedal sheath with a 260 cm Glidewire Advantage (GWA) (Terumo) to cross the distal cap of the right SFA occlusion (Figure 2A). Stents were post dilated with a 6.0 mm balloon (Figure 2C).