“Crisscross” Approach: An Unconventional Technique for Simultaneous Antegrade and Retrograde Catheterization through Femoral Access
Background: Contralateral retrograde femoral (crossover) approach is the preferred modality for revascularization of iliac, femoral, popliteal, and tibial vessel in patients with chronic limb-threatening ischemia (CLTI). This approach, however, can be demanding in patients with tortuous iliac arteri...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2024-12-01
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| Series: | Indian Journal of Vascular and Endovascular Surgery |
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| Online Access: | https://journals.lww.com/10.4103/ijves.ijves_87_24 |
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| author | Siju T Abraham Vishnu Motukuru Vivek Anand KB Sumanth Raj |
| author_facet | Siju T Abraham Vishnu Motukuru Vivek Anand KB Sumanth Raj |
| author_sort | Siju T Abraham |
| collection | DOAJ |
| description | Background:
Contralateral retrograde femoral (crossover) approach is the preferred modality for revascularization of iliac, femoral, popliteal, and tibial vessel in patients with chronic limb-threatening ischemia (CLTI). This approach, however, can be demanding in patients with tortuous iliac arteries, distal aortic calcification, and scarred contralateral groin. Flip techniques have been successfully deployed as an alternative to crossover approach to deal with concomitant iliac artery and infrainguinal lesions. Nevertheless, flip techniques have also been associated with complications such as loss of access and dissection at access site. We describe a unique “crisscross” technique which involves concurrent use of retrograde and antegrade sheaths through femoral access for the treatment of ipsilateral iliac and infrainguinal lesions with focus on procedural outcomes and complications.
Materials and Methods:
This is a case series of 22 patients who underwent percutaneous “crisscross” access for recanalization of lower limb lesions between January 2020 and April 2024. Outcomes were measured included technical and hemodynamic success, and access related complications such as hematoma, bleeding, and pseudoaneurysm formation.
Results:
Of the 22 cases, retrograde common femoral artery access using 7 Fr sheath was obtained in 15 (68.2%) patients for recanalization of iliac lesion (2 patients had conversion from diagnostic 5 Fr to therapeutic 7 Fr sheath). In the remaining 7 (31.8%) patients, 5 Fr retrograde sheath was utilized for diagnostic iliac artery digital subtraction angiogram due to inconclusive preoperative clinical and radiological findings. All 22 (100%) patients underwent successful infrainguinal revascularization using 6 Fr antegrade sheath across the proximal superficial femoral artery. Technical and hemodynamic success was achieved in all 22 patients. Only 2 (9.1%) patients developed mild hematoma at the access site with no major access related complications.
Conclusion:
“Crisscross” technique can be considered a safe and effective approach for revascularization of ipsilateral concomitant iliac artery and infrainguinal lesions in patients with CLTI. |
| format | Article |
| id | doaj-art-13eb0f19fa424572a88ac7975dc2d876 |
| institution | Kabale University |
| issn | 0972-0820 2394-0999 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Vascular and Endovascular Surgery |
| spelling | doaj-art-13eb0f19fa424572a88ac7975dc2d8762025-01-10T10:36:15ZengWolters Kluwer Medknow PublicationsIndian Journal of Vascular and Endovascular Surgery0972-08202394-09992024-12-0111426727310.4103/ijves.ijves_87_24“Crisscross” Approach: An Unconventional Technique for Simultaneous Antegrade and Retrograde Catheterization through Femoral AccessSiju T AbrahamVishnu MotukuruVivek AnandKB Sumanth RajBackground: Contralateral retrograde femoral (crossover) approach is the preferred modality for revascularization of iliac, femoral, popliteal, and tibial vessel in patients with chronic limb-threatening ischemia (CLTI). This approach, however, can be demanding in patients with tortuous iliac arteries, distal aortic calcification, and scarred contralateral groin. Flip techniques have been successfully deployed as an alternative to crossover approach to deal with concomitant iliac artery and infrainguinal lesions. Nevertheless, flip techniques have also been associated with complications such as loss of access and dissection at access site. We describe a unique “crisscross” technique which involves concurrent use of retrograde and antegrade sheaths through femoral access for the treatment of ipsilateral iliac and infrainguinal lesions with focus on procedural outcomes and complications. Materials and Methods: This is a case series of 22 patients who underwent percutaneous “crisscross” access for recanalization of lower limb lesions between January 2020 and April 2024. Outcomes were measured included technical and hemodynamic success, and access related complications such as hematoma, bleeding, and pseudoaneurysm formation. Results: Of the 22 cases, retrograde common femoral artery access using 7 Fr sheath was obtained in 15 (68.2%) patients for recanalization of iliac lesion (2 patients had conversion from diagnostic 5 Fr to therapeutic 7 Fr sheath). In the remaining 7 (31.8%) patients, 5 Fr retrograde sheath was utilized for diagnostic iliac artery digital subtraction angiogram due to inconclusive preoperative clinical and radiological findings. All 22 (100%) patients underwent successful infrainguinal revascularization using 6 Fr antegrade sheath across the proximal superficial femoral artery. Technical and hemodynamic success was achieved in all 22 patients. Only 2 (9.1%) patients developed mild hematoma at the access site with no major access related complications. Conclusion: “Crisscross” technique can be considered a safe and effective approach for revascularization of ipsilateral concomitant iliac artery and infrainguinal lesions in patients with CLTI.https://journals.lww.com/10.4103/ijves.ijves_87_24antegrade superficial femoral artery accesscrisscross techniqueretrograde common femoral artery accesssimultaneous antegrade–retrograde access |
| spellingShingle | Siju T Abraham Vishnu Motukuru Vivek Anand KB Sumanth Raj “Crisscross” Approach: An Unconventional Technique for Simultaneous Antegrade and Retrograde Catheterization through Femoral Access Indian Journal of Vascular and Endovascular Surgery antegrade superficial femoral artery access crisscross technique retrograde common femoral artery access simultaneous antegrade–retrograde access |
| title | “Crisscross” Approach: An Unconventional Technique for Simultaneous Antegrade and Retrograde Catheterization through Femoral Access |
| title_full | “Crisscross” Approach: An Unconventional Technique for Simultaneous Antegrade and Retrograde Catheterization through Femoral Access |
| title_fullStr | “Crisscross” Approach: An Unconventional Technique for Simultaneous Antegrade and Retrograde Catheterization through Femoral Access |
| title_full_unstemmed | “Crisscross” Approach: An Unconventional Technique for Simultaneous Antegrade and Retrograde Catheterization through Femoral Access |
| title_short | “Crisscross” Approach: An Unconventional Technique for Simultaneous Antegrade and Retrograde Catheterization through Femoral Access |
| title_sort | crisscross approach an unconventional technique for simultaneous antegrade and retrograde catheterization through femoral access |
| topic | antegrade superficial femoral artery access crisscross technique retrograde common femoral artery access simultaneous antegrade–retrograde access |
| url | https://journals.lww.com/10.4103/ijves.ijves_87_24 |
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