Bilateral Transankle Intervention as a Critical Determinant of Successful Revascularisation in Complex Peripheral Arterial Disease
Introduction: Establishing optimal vascular access sites is important for the procedural success of endovascular treatment (EVT) and the patient's comfort afterwards. Among the variety of vascular access sites, the transankle intervention (TAI) has been used more recently; however, there have b...
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Elsevier
2024-01-01
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| Series: | EJVES Vascular Forum |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666688X24001345 |
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| author | Tetsuya Nomura Naotoshi Wada Kenshi Ono Keisuke Shoji |
| author_facet | Tetsuya Nomura Naotoshi Wada Kenshi Ono Keisuke Shoji |
| author_sort | Tetsuya Nomura |
| collection | DOAJ |
| description | Introduction: Establishing optimal vascular access sites is important for the procedural success of endovascular treatment (EVT) and the patient's comfort afterwards. Among the variety of vascular access sites, the transankle intervention (TAI) has been used more recently; however, there have been no reports of complex lower extremity arterial disease lesions treated with the TAI manoeuvre. Report: An 82 year old man with chronic limb threatening ischaemia in both lower extremities underwent EVT for bilateral long segment occlusion from the iliac arteries to the superficial femoral artery (SFA). The right posterior tibial artery was punctured under extravascular ultrasound guidance and a Parent Select 5082 guide sheath was inserted. The guidewire was manipulated under intravascular ultrasound (IVUS) guidance. When the first guidewire entered the subintimal space, the second guidewire was manipulated to advance through the intraplaque route, while monitoring it using IVUS. The intraluminal space of the right common iliac artery was reached by repeating these procedures. A self expandable stent was deployed in the external iliac artery and drug coated balloons were inflated from the common femoral artery to the SFA; good vascular patency and favourable blood flow were confirmed. Subsequently, a similar TAI procedure was performed from the left dorsalis pedis artery, and successful revascularisation was achieved from the left common iliac artery to the SFA. After revascularisation, the persistent pain disappeared in the right lower limb and the wound healed favourably in the left lower limb. Conclusion: In this case of complex chronic limb threatening ischaemia, the TAI strategy worked favourably for successful revascularisation. Transankle intervention can provide various advantages for successful EVT. |
| format | Article |
| id | doaj-art-d041fce2c38844059e1fec5eb89c1adc |
| institution | Kabale University |
| issn | 2666-688X |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EJVES Vascular Forum |
| spelling | doaj-art-d041fce2c38844059e1fec5eb89c1adc2024-12-15T06:17:25ZengElsevierEJVES Vascular Forum2666-688X2024-01-01623034Bilateral Transankle Intervention as a Critical Determinant of Successful Revascularisation in Complex Peripheral Arterial DiseaseTetsuya Nomura0Naotoshi Wada1Kenshi Ono2Keisuke Shoji3Corresponding author. Department of Cardiovascular Medicine, Kyoto Chubu Medical Centre, 25, Yagi-Ueno, Yagi-cho, Nantan City, Kyoto 629-0197, Japan.; Department of Cardiovascular Medicine, Kyoto Chubu Medical Centre, Kyoto, JapanDepartment of Cardiovascular Medicine, Kyoto Chubu Medical Centre, Kyoto, JapanDepartment of Cardiovascular Medicine, Kyoto Chubu Medical Centre, Kyoto, JapanDepartment of Cardiovascular Medicine, Kyoto Chubu Medical Centre, Kyoto, JapanIntroduction: Establishing optimal vascular access sites is important for the procedural success of endovascular treatment (EVT) and the patient's comfort afterwards. Among the variety of vascular access sites, the transankle intervention (TAI) has been used more recently; however, there have been no reports of complex lower extremity arterial disease lesions treated with the TAI manoeuvre. Report: An 82 year old man with chronic limb threatening ischaemia in both lower extremities underwent EVT for bilateral long segment occlusion from the iliac arteries to the superficial femoral artery (SFA). The right posterior tibial artery was punctured under extravascular ultrasound guidance and a Parent Select 5082 guide sheath was inserted. The guidewire was manipulated under intravascular ultrasound (IVUS) guidance. When the first guidewire entered the subintimal space, the second guidewire was manipulated to advance through the intraplaque route, while monitoring it using IVUS. The intraluminal space of the right common iliac artery was reached by repeating these procedures. A self expandable stent was deployed in the external iliac artery and drug coated balloons were inflated from the common femoral artery to the SFA; good vascular patency and favourable blood flow were confirmed. Subsequently, a similar TAI procedure was performed from the left dorsalis pedis artery, and successful revascularisation was achieved from the left common iliac artery to the SFA. After revascularisation, the persistent pain disappeared in the right lower limb and the wound healed favourably in the left lower limb. Conclusion: In this case of complex chronic limb threatening ischaemia, the TAI strategy worked favourably for successful revascularisation. Transankle intervention can provide various advantages for successful EVT.http://www.sciencedirect.com/science/article/pii/S2666688X24001345Transankle interventionEndovascular treatmentCritical limb threatening ischaemiaIntravascular ultrasoundParallel wiring |
| spellingShingle | Tetsuya Nomura Naotoshi Wada Kenshi Ono Keisuke Shoji Bilateral Transankle Intervention as a Critical Determinant of Successful Revascularisation in Complex Peripheral Arterial Disease EJVES Vascular Forum Transankle intervention Endovascular treatment Critical limb threatening ischaemia Intravascular ultrasound Parallel wiring |
| title | Bilateral Transankle Intervention as a Critical Determinant of Successful Revascularisation in Complex Peripheral Arterial Disease |
| title_full | Bilateral Transankle Intervention as a Critical Determinant of Successful Revascularisation in Complex Peripheral Arterial Disease |
| title_fullStr | Bilateral Transankle Intervention as a Critical Determinant of Successful Revascularisation in Complex Peripheral Arterial Disease |
| title_full_unstemmed | Bilateral Transankle Intervention as a Critical Determinant of Successful Revascularisation in Complex Peripheral Arterial Disease |
| title_short | Bilateral Transankle Intervention as a Critical Determinant of Successful Revascularisation in Complex Peripheral Arterial Disease |
| title_sort | bilateral transankle intervention as a critical determinant of successful revascularisation in complex peripheral arterial disease |
| topic | Transankle intervention Endovascular treatment Critical limb threatening ischaemia Intravascular ultrasound Parallel wiring |
| url | http://www.sciencedirect.com/science/article/pii/S2666688X24001345 |
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