title: Transcollateral retrograde approach with rendezvous technique for recanalization of chronically occluded tibial arteries.
abstract: OBJECTIVE
  To describe a novel technique using an antegrade wire in a retrograde microcatheter advanced through a transcollateral vessel for recanalization of challenging infrapopliteal chronic total occlusions.
  
  
  METHODS
  A 75-year-old diabetic man presented with critical limb ischemia manifested as nonhealing ulcers on the toes. Baseline angiography revealed a blunt, long, total occlusion of the anterior tibial artery. A retrograde microcatheter was advanced over a guidewire tracking the collateral channel from the planter artery. Antegrade and retrograde microcatheters were aligned inside the occluded lesion. An antegrade wire was then advanced further down through the retrograde microcatheter. Final angiography of the anterior tibial artery following balloon dilation demonstrated a satisfactory result, without evidence of significant residual stenoses or flow-limiting dissections. Complete wound healing was achieved at 3 weeks.
  
  
  CONCLUSIONS
  This alternative wire method may be useful when traditional interventional approaches are unfeasible.
authors.affiliation: Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan. shimada@shiroyama-hsp.or.jp
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Shimada
authors.forename: Naoto
authors.initials: N
authors.lastname: Kino
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yano
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tonomura
authors.forename: Kosuke
authors.initials: K
authors.lastname: Takehara
authors.forename: Keiichi
authors.initials: K
authors.lastname: Furubayashi
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kurotobi
authors.forename: Takao
authors.initials: T
authors.lastname: Tsuchida
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fukumoto
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002908:Chronic Disease; D003097:Collateral Circulation; D003251:Constriction, Pathologic; D017719:Diabetic Foot / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D004867:Equipment Design; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008904:Miniaturization; D011859:Radiography; D012039:Regional Blood Flow; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014945:Wound Healing