Marta Lobato & August Ysa
Donald Garbett commented on presentation Extreme retrograde metatarsal puncture in a complex CLI case.
Recorded webinar – Percutaneous Venous Arterialization
Up to 20% of patients with Critical Limb Ischemia (CLI) are not considered good candidates for endovascular revascularization. If recanalization of a chronic occlusion of a BTK/ BTA artery proves to be impossible owing to the inability to cross an extensive occlusion or in the presence of a “desert foot”, percutaneous venous arterialization has proven to be a bailout strategy for limb salvage. Drs. August Ysa and Marta Lobato, from Vascular Surgery Dpt. Hospital de Cruces, Barakaldo (Spain), present the last update in Percutaneous Venous Arterialization technique and expose a Case in the box.
Extreme retrograde metatarsal puncture in a complex CLI case
After an unsuccessful antegrade recanalization attempt of the ATA/DP due to vessel perforation, an extreme retrograde puncture of the first metatarsal artery was performed. Following a 1.5 mm balloon dilatation, the rendezvous of the wires was obtained using the CART technique. 2 mm DCB balloon angioplasty of the DP, 2.5mm for the distal ATA and 3mm for the proximal ATA were subsequently performed. The completion angio showed full blushing of the target lesion, and excellent flow on the forefoot including the plantar arch.
Daniel Mendes-Pinto commented on presentation TUTORIAL VIDEO: Venous arterialization using conventional “off-the-shelf” devices.
TUTORIAL VIDEO: Venous arterialization using conventional “off-the-shelf” devices
Although we favor a more distal location of the AVF to circumvent the need to use covered stent extensions to destroy the valves and avoid bleeding off venous flow via collaterals, sometimes (e.g. due to extreme vessel calcification) it is unavoidable to have to look for a more proximal inflow. The versatility of the VAST maneuver allows to perform a proximal DVA at the origin of the PT artery with conventional off-the-shelf devices.”
JEVT 2019 Apr;26(2):213-218
JEVT 2019 Jun;26(3):427-428