title: The "Safari" technique to perform difficult subintimal infragenicular vessels.
abstract: The purpose of this study was to describe the efficacy of planned combined subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) to obtain the precise recanalization of the patent portion of a distal runoff vessel in critical limb ischemia (CLI) patients presenting long occlusions involving the popliteal trifurcation. Four patients at risk of limb loss due to long occlusions involving the leg vessel tree and not suitable for a surgical bypass were treated by the subintimal antegrade and retrograde (posterior tibial or anterior tibial artery) approach. The patent portion of the runoff vessel was previously assessed by magnetic resonance angiography (MRA) and directly punctured under Doppler ultrasound (US) guidance. A subintimal channel rendezvous was performed to allow snaring of the guidewires. Subsequently, a balloon dilatation was performed without stent deployment. All patients were successfully recanalized and had complete healing of the limb lesions. At the 12-month follow-up all patients showed clinical improvement with no major complications related to the procedure. This combined antegrade and retrograde subintimal approach is currently an excellent endovascular option in patients with long occlusions extending onto the leg vessels trifurcation and at risk of limb loss.
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gandini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pipitone
authors.forename: Matteo
authors.initials: M
authors.lastname: Stefanini
authors.forename: Luciano
authors.initials: L
authors.lastname: Maresca
authors.forename: Alessio
authors.initials: A
authors.lastname: Spinelli
authors.forename: Vittorio
authors.initials: V
authors.lastname: Colangelo
authors.forename: Carlo Andrea
authors.initials: CA
authors.lastname: Reale
authors.forename: Enrico
authors.initials: E
authors.lastname: Pampana
authors.forename: Giovanni
authors.initials: G
authors.lastname: Simonetti
mesh_terms: D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D016909:Tibial Arteries / Q000601:surgery*; D017539:Tunica Intima / Q000601:surgery*; D018608:Ultrasonography, Doppler / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*