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BTK arteries angioplasty: Optimal Complex recanalization for BTK arteries

Case of the month: March 2019

This didactic procedure concerns a 70 years old man, with multiple Cardiovascular risk factors, presenting severe Leftt limb critical ischemia with extensive gangrene in the II-III & IV toes.
He was treated by complete revascularization of both Anterior tibial artery  (True to true lumen) & Posterior tibial artery recanalization, Good final angiographic  result with acceptable Run off.
 

Educational objectives

  • How to manage patients with Critical Limb ischemia & BTK vessels reocclusion.
  • Optimal techniques to achieve complete revascularization in Critical Limb ischemia.
  • How to minimize iodine contrast use during BTK revascularization procedures.
  • Carboxy-dioxide angiography during BTK revascularization procedures.
  • Drug Coated Balloon in BTK arteries.

Step-by-Step description 

  • Left CFA antegrade Access with 6F Sheath.
  • Crossing Anterior tibial artery  true lumen with 0.014 guidewire Command ES (Abbott).
  • Crossing the Plantar Arch through the Dorsalis pedis artery using the Command ES guide wire & Ultraverse Balloon 2.0x40mm (BARD).
  • Retrograde Crossing  of the Posterior tibial artery till the proximal artery.
  • Predilatation of the Anterior tibial artery & the plantar arch.
  • Antegrade Crossing of the Posterior tibial artery with a second Command 0.014 guidewire (Abbott).
  • Multilevel predilatation of the Posterior tivbial artery.
  • Drug Coated balloon dilatation only for  Anterior tibial artery.
  • Second Balloon diltation of the Posterior tibial artery & the plantar arch.
  • Final angiographic control with acceptable Run off & good patency of the ATA, PTA & plantar arch.

Biobliography



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