title: Tips and tricks for a correct "endo approach".
abstract: The world is facing an epidemic of diabetes, consequently in the next years critical limb ischemia due to diabetic artery disease will become a major issue for vascular and endovascular operators. Revascularization is a key therapy in these patients because reestablishing an adequate blood supply to the wound is essential for healing avoiding a major amputation. In this paper, we summarize our experience in endovascular treatment of diabetic critical limb ischemia, focusing of the main technical challenges in treating below-the-knee vessels. We describe the following topics: 1) targets of the revascularization therapy: "complete" versus "partial" revascularization and the concept of wound related artery. Every procedure must be tailored on technically realistic strategies and on the general patient status; 2) the antegrade femoral access using both, the X-ray and the ultrasound guided techniques; 3) the chronic total occlusions crossing strategy proposing a step-by-step approach: endoluminal, subintimal, retrograde approaches. Particular attention has been given to the different retrograde approaches: pedal-plantar loop technique, trans-collateral approaches and the different types of retrograde puncture. For each step we provide a complete description of the technical details and of the suitable devices. Eventually we in brief describe: 3) acute result optimization and 4) prevention of restenosis.
authors.affiliation: Peripheral Interventional Cathlab, Diabetic Foot Clinic Istituto Clinico Città Studi, Milan, Italy - ferraresi.md@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Ferraresi
authors.forename: L M
authors.initials: LM
authors.lastname: Palena
authors.forename: G
authors.initials: G
authors.lastname: Mauri
authors.forename: M
authors.initials: M
authors.lastname: Manzi
mesh_terms: D017719:Diabetic Foot / Q000601:surgery*; D057510:Endovascular Procedures / Q000592:standards*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*