title: Combined Radial-Pedal Access Strategy and Radial-Pedal Rendezvous in the Revascularization of Complex Total Occlusions of the Superficial Femoral Artery (the "No Femoral Access" Strategy).
abstract: OBJECTIVE
  To describe the combined use of radial-pedal access for recanalization of complex superficial femoral artery (SFA) occlusions unsuitable for transfemoral recanalization.
  
  
  METHODS
  Patients are selected for this strategy if they have a long (≥ 10 cm) SFA occlusion with unfavorable aortoiliac anatomy, an absent ostial stump, or severely diseased and calcified distal reconstitution. Left radial artery and distal anterior or posterior tibial artery are accessed with 6-F and 4-F sheaths, respectively. The SFA lesion is crossed retrogradely with a 0.035-inch wire system. If retrograde crossing is not immediately successful, transradial subintimal tracking and radial-pedal subintimal rendezvous are used to allow retrograde reentry. Fifteen patients (mean age 62 ± 5 years; 11 men) have been treated in this fashion, and frequently stented, through the tibiopedal access. Seven patients required radial-pedal rendezvous to facilitate retrograde reentry. Two patients underwent transradial iliac stenting during the same session, and 1 patient underwent transradial kissing angioplasty of the profunda. No major complication occurred in any patient. After the procedure, the pulse across the accessed tibial artery was palpable in all patients.
  
  
  CONCLUSIONS
  In patients with long and complex SFA occlusion unsuitable for transfemoral recanalization, a radial-pedal strategy can overcome revascularization obstacles.
authors: Department of Medicine, Cardiovascular Section, Louisiana State University, New Orleans, LA, USA ehanna@lsuhsc.edu.
authors: Elias B
authors: EB
authors: Hanna
authors: Department of Medicine, Cardiovascular Section, Louisiana State University, New Orleans, LA, USA.
authors: Davey L
authors: DL
authors: Prout
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014654:Vascular Patency
keywords: angioplasty; controlled antegrade retrograde subintimal tracking; occlusion; pedal access; radial artery access; reentry; rendezvous technique; retrograde recanalization; stent; superficial femoral artery; tibiopedal access; transradial access