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Tips and Tricks for Simple and Complex Below-the-Ankle Punctures
August Ysa1, Marta Lobato1, Lorenzo Patrone2
1Department of Vascular Surgery, Hospital de Cruces, Barakaldo, Spain.
Summary
For chronic limb-threatening ischemia (CLTI) cases, complex retrograde pedal access techniques can improve endovascular procedure success when standard methods fail. Mastering distal below-the-ankle (BTA) punctures offers a viable alternative for challenging vessel occlusions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Chronic limb-threatening ischemia (CLTI) poses significant challenges in endovascular recanalization.
- Standard endovascular crossing techniques and retrograde access below the knee or ankle may fail due to extensive vessel occlusion.
Purpose of the Study:
- To review and present tips and tricks for complex retrograde pedal access techniques.
- To enhance procedural success rates in challenging CLTI cases.
Main Methods:
- Review of existing literature and case reports on retrograde pedal access.
- Description of techniques for mid- and forefoot retrograde punctures.
Main Results:
- Scanty reports exist on retrograde puncture of mid- and forefoot vessels.
- Detailed techniques can guide operators in specific challenging scenarios.
Conclusions:
- Mastering distal retrograde pedal access, including mid- and forefoot punctures, is advantageous when standard CLTI recanalization fails.
- These advanced techniques can improve procedural success rates in complex CLTI cases.
