Yonsei Med J.  2013 Mar;54(2):534-537. 10.3349/ymj.2013.54.2.534.

Dorsal-Plantar Loop Technique Using Chronic Total Occlusion Devices via Anterior Tibial Artery

• Kim S
• Choi D
• Shin S
• Shin DH
• Kim JS
• Kim BK
• Ko YG
• Hong MK
• Jang Y

• KMID: 1503922
• DOI: http://doi.org/10.3349/ymj.2013.54.2.534

Abstract

The effectiveness of below-the-knee (BTK) percutaneous transluminal angioplasty to obtain successful revascularization in patients with critical limb ischemia has been well established, and many of these patients with chronic lower-extremity disease have been treated by endovascular intervention as the firstline treatment. Dorsal-plantaer loop technique is one of the new BTK interventional techiniques, and includes recanalization of both pedal and plantar arteries and their anatomical anastomoses. This method generally needs two approaches simultaneously, including antegrade and retrograde. In this report, however, we describe a case in which dorsal-plantar loop technique with only one antegrade approach, using chronic total occlusion devices via anterior tibial artery, was used to successfully recanalize BTK arteries. We think that this new technique, which may represent a safe and feasible endovascular option to avoid more invasive, time-consuming, and riskier surgical procedures, especially in end-stage renal disease and diabetes, should be considered whenever the foot is at risk, and results of above-the-ankle percutaneous transluminal angioplasty remain unsatisfactory or insufficient to achieve limb salvage.

Keyword

Ischemia; peripheral arterial disease; angioplasty

MeSH Terms

Angioplasty, Balloon/*methods
Diabetic Foot/*therapy
Humans
Male
Middle Aged
Peripheral Arterial Disease/*therapy
*Tibial Arteries

Figure

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  Fig. 1 Baseline peripheral angiography. (A) Baseline angiography revealed total occlusion of the left infrapopliteal artery with proximal portion of three distal run-off vessels. (B) The flow of distal posterior tibial artery and lateral plantar artery is shown. (C and D) A diffuse wound is distributed on the entire area of the foot including the transpedal puncture site.

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  Fig. 2 Balloon angioplasty. (A and B) Balloon angioplasty of ATA using 3.0×100 mm EverCross balloon. (C) A 300-cm-long 014-inch hydrophilic guidewire was passed from ATA via a dorsal-plantar loop to PTA using the Corsair microcatheter. (D, E and F) Balloon angioplasty of dorsal-plantar loop (consisting of dorsalis pedis artery, deep plantar artery, deep plantar arch and lateral plantar artery) using 2.0×120 mm NanoCross balloon. (G and H) Balloon angioplasty of PTA using 3.0×100 mm EverCross balloon. ATA, anterior tibial artery; PTA, posterior tibial artery.

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  Fig. 3 (A-D) Final angiography. Final angiography reveals a well visualized anterior tibial artery, dorsal-plantar loop and posterior tibial artery with improved flow.

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