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Retrograde transpedal stenting of the tibioperoneal trunk in critical limb ischemia

Zoltán Ruzsa1, László Pintér, Ralf Kolvenbach

  • 1Department of Invasive Cardiology, County Hospital of Bács-Kiskun, Kecskemét, Hungary. zruzsa25@gmail.com

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|November 29, 2011
PubMed

Insights

This case report details a successful endovascular treatment for critical limb ischemia (CLI) using a dual transpedal approach and V stenting for a non-surgical tibioperoneal trunk occlusion. The study highlights the feasibility and safety of retrograde stenting in complex below-the-knee interventions.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Endovascular Interventions

Background:

  • Critical limb ischemia (CLI) management necessitates optimal medical therapy and revascularization.
  • Endovascular interventions are primary for limb revascularization, especially for below-the-knee (BTK) lesions in CLI patients where surgery is often unfeasible.

Observation:

  • This case report presents a successful percutaneous recanalization of a surgically untreatable tibioperoneal trunk occlusion.
  • A dual anterograde and retrograde transpedal approach was employed, utilizing a modified "V stenting" technique.
  • Bailout stenting via retrograde posterior tibial artery access was successfully performed after failed guidewire externalization.

Findings:

  • The retrograde approach using 4F compatible devices demonstrated feasibility, safety, and efficacy in treating complex BTK occlusions.
  • Successful recanalization and stenting of the tibioperoneal trunk were achieved, restoring limb perfusion.

Implications:

  • This technique offers a viable alternative for CLI patients with complex BTK lesions unsuitable for surgery.
  • The retrograde approach expands endovascular treatment options for limb salvage in challenging CLI cases.

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