PMC6300432_01
Pre-procedural angiogram shows the full metal jacket (A), the proximal superficial femoral artery occlusion (B), the distal recanalisation (C), and the below the knee outflow (D).
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fig1
Pre-procedural angiography confirmed the duplex findings (Fig. 1).
Percutaneous retrograde popliteal puncture with substent guidewire positioning (a) and sheath introduction (b); interrogation of the distal occlusion cap with Berenstein II catheter and a second 0.018 inch guidewire (c); recanalisation of the full metal jacket (d-h); re-entry into the popliteal artery with the antegrade 0.014 guidewire (i); and sequential angioplasty (j,k).
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fig2
Terumo, Somerset, NJ, USA) was placed with just the tip in the PA lumen (Fig. 2a and b). The distal end of the FMJ was interrogated with a 4 F type 2 Berenstein catheter and a second 0.018 inch V-18 Control guidewire, which was advanced intraluminally (Fig. 2c and d). The tip of the guidewire was immediately looped to avoid accidental extraluminal passage through the struts. The wire and the catheter were pushed up to the proximal SFA, re-entering in the CFA (Fig. 2e and f). From the antegrade sheath, a 0.014 inch nitinol wire (Hi-Torque Command ES, Abbott, Santa Rosa, CA, USA) was advanced through the occluded FMJ following the retrograde guidewire and reaching the PA (Fig. 2g and h). The guidewire crossed the PA and was positioned in the peroneal artery (Fig. 2i). Balloon angioplasty was performed via the antegrade approach (Fig. 2j and k) with 4.0x200 mm (Armada 14, Abbott, Santa Rosa, CA, USA) and 5.0x250 mm balloon catheters (Armada 35 LL, Abbott, Santa Rosa, CA, USA).
Completion angiograms before (a,b) and after sheath removal (c).
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The completion angiogram showed patency of the recanalised FMJ and PA with preservation of two vessel runoff (Fig. 3).