Nontraumatic Intraluminal Recanalization of Difficult Below-the-knee Total Occlusions using combination of IVUS Catheter Tip and Long Supporting Vascular Sheath
Purpose: To evaluate safety and effectiveness of an innovative technique of combining IVUS tip and a long supporting sheath with tip in the intended below-the-knee artery to treat total occlusion
Materials and Methods: Fourteen patients underwent conventional antegrade crossing techniques for below the knee tibial artery CTO using weighted tip wires and crossing catheters (Abbott). All had failed. The proximal calcium cap was confronted by the tip of an IVUS catheter (Philips), after a 5 F long supporting sheath was placed in the tibial artery. The IVUS tip was used to push against the CTO with the supoort of a Command wire (Abbott) inside, while intraluminal status of the crossing was confirmed by the live IVUS recordings. The IVUS tip was then pushed forward with firm but gentle pressure all the way down to the ankle. Angiogram was performed to confirm randevou of distal vessel. This was followed by additional atherectomy and angioplasty.
Results: Fourteen patients had average age of 73 (range 61-91), 2 smokers, 9 with left leg lesions, 12 are diabetic each underwent conventional contralatearl access anegrade corssing techniques using weighted tip wires (Abbott) and crossing catheters (Philips); and novel techniques using a 5 French supporting sheath (Cook) tip in the target below-the knee vessel and an IVUS catheter (Philips) tip as the main recnanalization device pushing inferiorly. Live IVUS recordings demonstrate intraluminal status. 13 patients were technically usccessful with patent target tibial vessel at the end of the procedure. 10 patients had 6 months patency based on ultrasound, and 3 had re-occlusion. Only 1 patient had extravasation during the procedure; 0 had post-op bleeding or hematoma in the calf.
Conclusion: Using an IVUS tip with a supporting long sheath in the target vessel is a safe and effective novel appoach to recanalize difficult tibial CTO.
