Subintimal angioplasty of an aortoiliac occlusion: re-entry site created using a transseptal needle under intravascular ultrasound guidance.
OBJECTIVE
To report the use of a transseptal needle to cross the intimal flap in subintimal angioplasty of a flush aortoiliac occlusion via a retrograde approach.


METHODS
A 53-year-old man with claudication of the right lower limb and an angiographically documented right aortoiliac occlusion was treated with subintimal angioplasty via an ipsilateral retrograde approach. After puncture of the right common femoral artery, a 0.035-inch hydrophilic guidewire was advanced via the subintimal space toward the aortic true lumen, but the wire could not re-enter the true lumen. A transseptal needle was used to puncture the intimal flap under intravascular ultrasound (IVUS) guidance. Angioplasty/stenting was performed successfully, and the patient's symptoms were relieved. Computed tomography at 15 months revealed patent stents.


CONCLUSIONS
The use of a transseptal needle to cross the intimal flap in total aortoiliac occlusions is technically feasible under IVUS guidance and enables successful angioplasty.
Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.
Jung Rae
JR
Cho
Jung-Sun
JS
Kim
Yoon-Hyeong
YH
Cho
Deok-Kyu
DK
Cho
Young-Guk
YG
Ko
Donghoon
D
Choi
Yangsoo
Y
Jang
Won-Heum
WH
Shim
Seung-Yun
SY
Cho
D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods; D001011:Aorta / Q000000981:diagnostic imaging* / Q000473:pathology; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D004867:Equipment Design; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging* / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009339:Needles; D011677:Punctures / Q000295:instrumentation; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional