Extreme Below-the-Knee Interventions: Retrograde Transmetatarsal or Transplantar Arch Access for Foot Salvage in Challenging Cases of Critical Limb Ischemia
Extreme Below-the-Knee Interventions: Retrograde Transmetatarsal or Transplantar Arch Access for Foot Salvage in Challenging Cases of Critical Limb Ischemia
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DOI：
10.1583/jevt-12-3998r.1
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发表时间：
2012-12-01
影响因子：
2.6
通讯作者：
Manzi, Marco
中科院分区：
文献类型：
--
作者：
Palena, Luis Mariano;Manzi, Marco
目的：描述高级逆行入路方法：2011年9月至2012年3月，28例严重肢体缺血（CLI）患者接受经跖骨或跖弓血管内治疗和保足。（24名男子;平均年龄71.9 ± 10.6岁）接受保足治疗，但顺行再通失败，并且在足部或足底动脉处的经皮逆行通路不可用。需要先进的逆行穿刺技术来再通靶血管，以恢复受损组织的血流。局部注射维拉帕米控制痉挛后，优先使用21-G针头进入第一跖背动脉。当第一跖骨动脉闭塞且透视下不可见时，直接穿刺足底弓。穿刺后，一个0.018-或0.014英寸的导丝和微鞘被插入逆行再通的足和胫动脉的球囊大小的靶vessel.Results：逆行经跖动脉通路25例，直接transplantar弓进入3。24例（86%）病例取得了技术成功（能够将球囊输送穿过病变并在标称压力下充气），其中
Purpose: To describe advanced retrograde access (transmetatarsal or transplantar arch) for endovascular treatment of critical limb ischemia (CLI) and foot salvage.Methods: From September 2011 to March 2012,28 CLI patients (24 men; mean age 71.9 +/- 10.6 years) being treated for foot salvage had failed antegrade recanalization, and percutaneous retrograde access at the pedal or plantar artery was unavailable. Advanced retrograde access techniques were required to recanalize the target vessel to restore blood flow to the compromised tissue. After local administration of verapamil to control spasm, the first dorsal metatarsal artery was preferentially accessed with a 21-G needle. When the first metatarsal artery was occluded and not fluoroscopically viewable, the plantar arch was punctured directly. After puncture, a 0.018- or 0.014-inch guidewire and microsheath were inserted for retrograde recanalization of the foot and tibial arteries with balloons sized to the target vessels.Results: Retrograde transmetatarsal artery access was performed in 25 cases and direct transplantar arch access in 3. Technical success (ability to deliver the balloon across the lesion and inflate it at nominal pressure) was achieved in 24 (86%) cases, with