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This didactic procedure concerns a 70 years old man, with multiple cardiovascular risk factors, presenting severe Left 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

Shooting date : 2018-03-23
Last update : 2021-05-11

Hi-Torque Command Guide Wire / Abbott

Take Command of your peripheral cases

Lutonix® 035 / Bard Medical

Drug Coated Balloon PTA Catheter | 5F

OptiRAY® / Guerbet

Optiray® contrast agent is lower osmolar, lower viscosity and nonionic.
3 comments
Join the Discussion
  • Mangesh T. Very well done BTK & BTA Tibial Arterial DCB Plasty with excellent foot perfusion results.

    But Why not use “Phoenix Hybrid (Rotational & Directional) Atherectomy device for debulking heavily calcified distal PTA & dorsal Foot arch or at least Shockwave Lithoplasty balloons to beat Calcium??

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    • v22e V. Excelent case

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      • v22e V. Thanks

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