Korean Circ J.  2012 Feb;42(2):125-128. 10.4070/kcj.2012.42.2.125.

Below the Knee Intervention Using Multidisciplinary Methods Including an Antegrade, Retrograde Approach Without the Use of a Sheath but With a Plaque Excision Device

• An HM
• Kang WY
• Kim YH
• Lim CH
• Hwang SH
• Kim W
• Kim W

• KMID: 1826386
• DOI: http://doi.org/10.4070/kcj.2012.42.2.125

Abstract

Below the knee (BTK) interventions are increasing in patients with rest pain or critical limb ischemia, and these interventions are frequently successful in facilitating limb salvage. New intervention techniques and devices allow successful recanalization of occluded BTK arteries. Here, we report a case of successful recanalization of BTK arteries using multidisciplinary methods, including an antegrade approach and retrograde approach without the use of a sheath, but with simple balloon angioplasty, and plaque excision using Silverhawk atherectomy device.

Keyword

Peripheal arterial disease; Ischemia; Angioplasty; Atherectomy

MeSH Terms

Angioplasty
Angioplasty, Balloon
Arteries
Atherectomy
Extremities
Humans
Ischemia
Knee
Limb Salvage

Figure

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  Fig. 1 Computed tomography and angioplasty of the lower extremities. A: computed tomography with contrast revealed diffuse significant arterial stenosis in the left proximal to mid superficial femoral artery, total occlusion in the left distal SFA, diffuse arterial stenosis in the left popliteal artery, and total occlusion of the left tibioperoneal trunk. B, C, and D: angiography revealed a patent left proximal SFA with total occlusion of the left distal SFA to the popliteal artery with a poor distal run-off vessel. SFA: superficial femoral artery.

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  Fig. 2 Wire passage via the posterior tibial artery. A: the left pedal artery was punctured using an 18 gauge Seldinger needle and the wire was advanced successfully. B: after advancing the wire up to the tibioperoneal trunk, a 3×100 mm Savvy balloon was placed, without ballooning, as a sheath substitute. C and D: after successfully crossing the wire, we pulled the wire via a right femoral sheath using a snare (10 mm, pfm Produkte fur die Medizin AG).

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  Fig. 3 Percutaneous transluminal angioplasty and plaque excision. A: we performed PTA in the left popliteal artery using a 3×100 mm Savvy balloon at 6-10 atm. B: plaque excision using the Silverhawk device.

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  Fig. 4 Final angiography demonstrated a good distal flow without residual stenosis.

Reference

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