title: Pedal-plantar loop technique for a challenging below-the-knee chronic total occlusion: a novel approach to percutaneous revascularization in critical lower limb ischemia.
abstract: Arterial revascularization by means of percutaneous transluminal angioplasty (PTA) is a mainstay in the management of patients with peripheral artery disease and critical limb ischemia (CLI). However, when employing standard approaches, percutaneous transluminal angioplasty (PTA) of below-the-knee arteries may fail in up to 20% of cases. In the present article, we report on a novel interventional strategy, the pedal-plantar loop technique, which we successfully employed in a patient with critical lower limb ischemia. This technique may sensibly increase success rates of PTA in very challenging total occlusions of below-the-knee arteries (e.g., those lacking a proximal occlusion stump). Technical points pertinent to this case are clearly illustrated, including the need to accurately choose guidewires and balloons of appropriate length, and the extensive use of the subintimal angioplasty technique.
authors.affiliation: Abano Terme Hospital, Abano Terme, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fusaro
authors.forename: Luca
authors.initials: L
authors.lastname: Dalla Paola
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005528:Foot / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D012039:Regional Blood Flow / Q000502:physiology; D016909:Tibial Arteries / Q000502:physiology; D016896:Treatment Outcome