RIVER Technique: Retrograde IVUS Endovascular Revascularization of Anomalous Tibial Chronic Total Occlusions
Shadi Halabi1, Eric Gonsiorowski2, Wael Gad3
1Department of Cardiology, Community Hospital, Powers Health, Munster, Indiana, USA; Indiana University School of Medicine, Indianapolis, Indiana, USA.
Case Summary:
A 62-year-old man presented with a long-standing history of a nonhealing ulcer to the left foot. Previous antegrade revascularization attempts failed. Retrograde access was obtained at the posterior tibial artery, but the wire traveled away from the tibial peroneal trunk and connected at the popliteal artery. Intravascular ultrasound confirmed intraluminal passage of the wire, which led to successful revascularization of the posterior tibial artery and ulcer healing.
Take-Home-Message:
The RIVER (Retrograde Intravascular ultrasound Endovascular Revascularization of Anomalous Tibial Chronic Total Occlusions) technique is a useful strategy for revascularization of anomalous tibial occlusions when standard antegrade approaches fail.
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