PMC4530141_01
Angiography showing total occlusion of the three vessels with distal flow in dorsalis pedis artery from collaterals.
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Baseline angiography revealed non-significant lesions in the superficial femoral and popliteal arteries and total occlusion of the distal segment of the popliteal artery along with the proximal portions of the three distal run-off vessels while demonstrating distal flow in the dorsalis pedis artery from collaterals (Fig. 1).
Intravenous cannula at the dorsum of the foot (a) and guidewire inside the dorsalis pedis artery (b).
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The dorsalis pedis artery was punctured at the dorsum of the foot with a 20-gauge IV cannula (cannula-over-needle device with internal diameter of 0.8 mm and length of 32 mm) under fluoroscopic guidance (Fig. 2a). Next, a 0.014-inch hydrophilic guidewire was inserted into the cannula and advanced through the lumen retrogradely (Fig. 2b).
Entrance of the guidewire into the guiding catheter.
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At that time, we were able to enter into the guiding catheter with the guidewire following successful guidewire passage via the tibialis anterior artery (Fig. 3).
(a) and (b) Final angiogram.
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Final angiography demonstrated that antegrade flow was restored with well-visualized anterior tibial and dorsalis pedis arteries (Fig. 4a and b).