title: Extravascular Revascularization of a Chronic Total Occlusion Using the Dual Bull's-Eye Technique.
abstract: To describe the dual bull's-eye technique to achieve successful extravascular revascularization of an occlusion after vessel perforation when the antegrade and retrograde catheters are too far apart for salvage with a reentry catheter.
  
  
  
  The dual bull's-eye technique, which is an adaptation of the "gun-sight" method for transjugular portosystemic shunt procedures, is demonstrated in a popliteal artery occlusion in which multiple recanalization attempts have produced vessel perforation. Via antegrade femoral and retrograde anterior tibial artery accesses, 10-mm Amplatz GooseNeck snares were advanced in plane from each access to rendezvous in the popliteal fossa to obtain through-and-through wire access. A 15-cm Chiba needle was advanced percutaneously in plane through both snares, and a hydrophilic guidewire was maneuvered across an extravascular tract parallel to the popliteal artery. The tract was carefully predilated, and a 5×100-mm Viabahn stent-graft was deployed across the extravascular tract.
  
  
  
  Owing to potential complications (limited patency, injury to adjacent structures) and only single-case use, this new technique should be considered a bailout strategy exclusively employed for limb salvage when traditional methods have failed and there are no viable surgical options.
authors: Baystate Vascular Services, Springfield, MA, USA slkahn@gmail.com.
authors: S Lowell
authors: SL
authors: Kahn
authors: Baystate Vascular Services, Springfield, MA, USA.
authors: Jeffrey L
authors: JL
authors: Kaufman
mesh_terms: D000800:Angioplasty, Balloon; D003251:Constriction, Pathologic; D005263:Femoral Artery; D006801:Humans; D023821:Limb Salvage; D058729:Peripheral Arterial Disease / Q000628:therapy*; D011150:Popliteal Artery; D015607:Stents; D016896:Treatment Outcome
keywords: angioplasty; chronic total occlusion; covered stent; critical limb ischemia; extravascular revascularization; perforation; popliteal artery; reentry catheter; snare