title: Retrograde Approach Using Surgical Cutdown Technique for Limb Salvage in a Case of Critical Limb Ischemia With Severely Calcified Tibial Occlusive Disease.
abstract: We here report a successful angioplasty for tibial artery occlusion using direct tibial puncture and subsequent retrograde approach under surgical cutdown technique. An 82-year-old man with ulcer/gangrene in first and second digits was referred to our hospital for endovascular therapy (EVT) of lower extremity ischemia. Diagnostic angiogram revealed anterior tibial artery (ATA) occlusion with severe calcification. Subintimal angioplasty was attempted using a 0.014-inch hydrophilic guidewire but was unsuccessful. A retrograde approach was subsequently attempted for ATA recanalization. However, because of severe calcification of dorsal pedis artery (DPA), percutaneous distal puncture was also unsuccessful. Direct puncture under surgical cutdown technique for DPA was subsequently performed and was successful. A 0.014-inch hydrophilic wire was advanced in retrograde fashion across the ATA occlusion and was used to access the microcatheter positioned at the proximal ATA via antegrade approach. Angioplasty of the ATA occlusion was performed using a 2.5-/3.0-mm tapered balloon. Completion angiogram revealed restoration of flow without dissection. Skin perfusion pressure was dramatically improved. Complete wound healing was achieved 5 months after EVT.
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan shiraki.tatsuya@gmail.com.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Shiraki
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Iida
authors.affiliation: Division of Kidney and Dialysis, Department of Internal Medicine, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Suemitsu
authors.affiliation: Depertment of Plastic Surgery, Shinsuma General Hospital, Kobe, Hyogo, Japan.
authors.forename: Yoriko
authors.initials: Y
authors.lastname: Tsuji
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Uematsu
mesh_terms: D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D003131:Combined Modality Therapy; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D011677:Punctures; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D014656:Vascular Surgical Procedures; D014945:Wound Healing
keywords: chronic total occlusion; critical limb ischemia; cutdown; endovascular therapy; retrograde approach