Modified bare-back micro-retrograde tibial arterial access to facilitate peripheral endovascular therapy

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Peripheral Arterial Disease Management

Background:

• Critical limb-threatening ischemia (CLTI) frequently involves complex peripheral arterial chronic total occlusions (CTOs).
• Traditional antegrade revascularization may be insufficient for these challenging CTOs.
• Retrograde revascularization techniques offer an alternative for managing complex CTOs.

Purpose of the Study:

• To describe a novel modified retrograde cannulation technique for treating complex peripheral arterial CTOs.
• To present a "bare back" technique that avoids conventional tibial access sheath placement.
• To highlight the advantages of this technique, including distal access for monitoring and retrograde delivery.

Main Methods:

• A modified retrograde approach utilizing a "bare back" technique was developed.
• This method bypasses the need for traditional tibial access sheaths.
• The technique facilitates distal arterial blood sampling, blood pressure monitoring, and retrograde contrast/vasoactive agent administration.

Main Results:

• The described cannulation strategy provides a simplified retrograde approach.
• It enables essential distal access functionalities without conventional sheaths.
• This technique can be integrated into the treatment of complex peripheral arterial occlusions.

Conclusions:

• A novel modified retrograde "bare back" cannulation technique is presented for CLTI patients.
• This approach offers an alternative to traditional methods for complex CTOs.
• The technique enhances the armamentarium for treating challenging peripheral arterial disease.