Pull-through approach to percutaneous angioplasty of totally occluded common iliac arteries.

A method has been developed to increase the probability of success of percutaneous transluminal balloon angioplasty of total occlusions of the common iliac artery when conventional methods have failed. In 10 patients with a totally obstructed iliac artery, a guide wire was passed through a catheter placed from the contralateral side around the aortic bifurcation and antegrade through the total obstruction. The end of the wire was either snared by a retrieval basket or guided through a sheath in the ipsilateral common femoral artery, thus providing a firmly anchored pathway for subsequent manipulations. Balloons were then inserted retrograde through both common femoral arteries and dilated. In the first five patients, ipsilateral retrograde passage of a guide wire had failed despite multiple attempts with a variety of devices. In the other five patients, the contralateral antegrade approach was used initially. The new method was successful in all 10 patients with totally obstructed common iliac arteries.