Korean Circ J.  2010 Feb;40(2):90-93. 10.4070/kcj.2010.40.2.90.

A Dual (Brachial and Contralateral Femoral) Approach for Subintimal Angioplasty of Long Ilio-Femoral Occlusive Disease Including the Iliac Ostium

• Woo JS
• Ha SJ
• Kim W

• KMID: 2297945
• DOI: http://doi.org/10.4070/kcj.2010.40.2.90

Abstract

As techniques and device technology have improved, the success rates and long patency of ilio-femoral occlusive disease have also improved. In the case of extensive iliac occlusive disease, however, wire passage and handling remain a challenge due to the relatively weak guiding catheter backup support with the contralateral femoral approach. There has been no report on methods to overcome this problem. We performed a successful percutaneous translunimal angioplasty for long ilio-femoral occlusive disease including the iliac ostium by a dual approach including simultaneous brachial and contralateral femoral arteries for subintimal angioplasty.

Keyword

Stents; Iliac artery; Percutaneous transluminal angioplasty

MeSH Terms

Angioplasty
Catheters
Femoral Artery
Handling (Psychology)
Iliac Artery
Stents

Figure

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  Fig. 1 Computed tomography-angiography (CTA) of the lower extremity. (A) shows total occlusion from the left common iliac artery ostium to the distal femoral artery with a reasonably collateralized circulation; after percutaneous transluminal angioplasty, the follow-up CTA revealed no residual stenosis from the common iliac artery to the distal femoral artery as shown in (B).

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  Fig. 2 Subintimal wiring for iliac occlusion through right brachial artery. Lower limb angiography via the right brachial artery revealed total occlusion of the left common iliac artery and left common femoral artery with collateral flow that reconstructed the distal superficial femoral artery as shown in (A). Using a 0.035 inch angled Terumo wire with a backup catheter; successful wiring from the common iliac artery to the external iliac artery was performed by subintimal wire tracking as shown in (B). After predilation (C), subintimal dye staining was noted as shown in (D).

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  Fig. 3 Subintimal wiring for superficial femoral artery occlusion via the contralateral femoral artery. A six French Balkin sheath was inserted through the contralateral femoral artery (A), and a 0.035 inch angled Terumo wire was successfully passed through the superficial femoral artery by the antegrade approach via the right femoral artery (B). A 10.0×60 mm peripheral self-expandable stent (Smart, Cordis) was deployed in the common iliac artery to the external iliac artery (C). Percutaneous transluminal angioplasty for the common iliac artery and superficial femoral artery was carried out (D).

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  Fig. 4 Final angiography. After percutaneous transluminal angioplasty, patent stents with good distal flow were noted.

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