BTK arteries angioplasty: Optimal Complex recanalization for BTK arteries (Drug Coated Balloon angioplasty for Re-Occlusion)

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

• Peripheral Arterial Diseases (Diagnosis and Treatment of) ESC Clinical Practice Guidelines - Guidelines
  Authors:Victor Aboyans  Jean-Baptiste Ricco  Marie-Louise E L Bartelink
  Publication: European Heart Journal (2018) 39, 763–821
   
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• One Year Primary Patency of Infrapopliteal Angioplasty Using Drug- Eluting Balloons: Single Center Experience at King Hussein Medical Center. - Article 
  Authors:Haddad SE, Shishani JM, Qtaish I, Rawashdeh MA, Qtaishat BS.
  Publication:doi: 10.4103/jcis.JCIS_34_17. eCollection 2017.
   
• Drug-coated balloon angioplasty for the management of recurring infrapopliteal disease in diabetic patients with critical limb ischemia.ink title - Article
  Authors:Palena LM, Diaz-Sandoval LJ, Gomez-Jaballera E, Peypoch-Perez O, Sultato E, Brigato C, Brocco E, Manzi M.
  Publication: doi: 10.1016/j.carrev.2017.06.006. Epub 2017 Jun 20.
   
• Automated Carbon Dioxide Angiography for the Evaluation and Endovascular Treatment of Diabetic Patients With Critical Limb Ischemia. - Article
  Authors:Palena LM, Diaz-Sandoval LJ, Gomez-Jaballera E, Peypoch-Perez O, Sultato E, Brigato C, Brocco E, Manzi M.
  Publication:doi: 10.1016/j.carrev.2017.06.006. Epub 2017 Jun 20.