title: Antegrade pedal approach for recanalizing occlusions in the opposing circulatory pathway of the foot when a retrograde puncture is not possible.
abstract: OBJECTIVE
  To describe a novel technical strategy to approach below-the-ankle chronic total occlusions after failed antegrade recanalization in patients who are not candidates for retrograde puncture.
  
  
  METHODS
  After a failure of antegrade recanalization of the tibial and foot vessels, an antegrade pedal access can be performed in the pedal or plantar artery. After crossing the plantar arch and the occlusions in the opposing circulation pathway of the foot, a rendezvous with the antegrade catheter is performed, followed by final angioplasty and hemostasis.
  
  
  CONCLUSIONS
  An antegrade pedal approach to the opposing circulation in the foot may be considered for below-the-ankle recanalization after standard antegrade recanalization failure in patients who are not candidates for a retrograde puncture.
authors.affiliation: Interventional Radiology Unit, Foot & Ankle Clinic, Policlinico Abano Terme, Italy.
authors.forename: Luis Mariano
authors.initials: LM
authors.lastname: Palena
authors.forename: Marco
authors.initials: M
authors.lastname: Manzi
mesh_terms: D000671:Amputation, Surgical; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods*; D002908:Chronic Disease; D005528:Foot / Q000098:blood supply*; D006801:Humans; D023821:Limb Salvage; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011677:Punctures; D012039:Regional Blood Flow; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: amputation; angioplasty; antegrade approach; below-the-ankle vessels; below-the-knee angioplasty; chronic total occlusion; critical limb ischemia; diabetes; limb salvage; pedal artery; plantar artery; recanalization; tibial artery