Direct occluded vessel puncture technique as a new access site for complex peripheral artery occlusive disease

A 77-year-old male was admitted to our hospital for severe intermittent claudication of both legs. He was diagnosed with aorto-iliac occlusions and a right femoro-popliteal artery occlusion with a diseased common femoral artery by a computed tomography angiography of the lower limb. We planned endovascular therapy for these multi-level occlusive lesions. The aorto-iliac lesion of the left side was antegradely recanalized via the left brachial artery. That of the right side was recanalized retrogradely by a direct occlusive vessel puncture (DOVP) with a dedicated 20 G needle and the Hi-Torque Command 18 ST. After stenting, his symptoms were completely relieved without revascularization of right femoro-popliteal artery, and he was discharged without any complications. The DOVP may also be used as an alternative option when there is not an appropriate approach site. <Learning objective: The appropriate selection of the access site for peripheral artery occlusive disease (PAOD) is one of the most important factors to obtain a successful guidewire recanalization. We occasionally encounter multi-level PAOD without an appropriate access site. The direct occluded vessel puncture should be considered as an alternative option.>.