Hayakawa Naoki, Kodera Satoshi, Arakawa Masataka, Kanda Junji
Department of Cardiovascular Medicine, Asahi General Hospital, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan.
Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan.
CVIR Endovasc. 2020 Sep 5;3(1):63. doi: 10.1186/s42155-020-00156-9.
There are still cases that are difficult to treat for femoropopliteal chronic total occlusion (CTO). The Outback® Elite catheter is effective re-entry device to treat such kind of difficult cases, however, it might be difficult to use the Outback® Elite catheter antegradely in cases with severely calcified lesions. In this case, we performed EVT using the Outback Elite® catheter via the retrograde popliteal approach.
We report a case of a 77-year-old male with end-stage renal disease who presented with pain and cyanosis of his left foot. Control angiography showed total occlusion from the middle of the left superficial femoral artery to the proximal portion of the popliteal artery. The CTO lesion was severely calcified, which prevented the antegrade advancement of any guidewire. Retrograde popliteal puncture was performed with the patient in the supine position. After intentional retrograde subintimal wiring, the Outback® Elite catheter was advanced via the retrograde approach after the identification of a suitable re-entry site using intravascular ultrasound. After wire crossing, one nitinol stent was deployed and sufficient antegrade flow was achieved without any complications.
Using Outback® Elite from retrograde should be considered in cases where antegrade advancement fails and bidirectional wiring cannot pass through the CTO lesion.
股腘动脉慢性完全闭塞（CTO）仍有一些难以治疗的病例。Outback® Elite导管是治疗此类疑难病例的有效再入路装置，然而，在病变严重钙化的情况下，可能难以顺行使用Outback® Elite导管。在本病例中，我们通过逆行腘动脉入路使用Outback Elite®导管进行了腔内血管成形术（EVT）。
我们报告一例77岁终末期肾病男性患者，其表现为左足疼痛和发绀。对照血管造影显示左股浅动脉中段至腘动脉近端完全闭塞。CTO病变严重钙化，导致任何导丝均无法顺行推进。患者仰卧位行逆行腘动脉穿刺。在有意进行逆行内膜下导丝置入后，使用血管内超声确定合适的再入路部位，然后通过逆行入路推进Outback® Elite导管。导丝通过病变后，置入一枚镍钛合金支架，实现了充足的顺行血流，且未发生任何并发症。
在顺行推进失败且双向导丝无法通过CTO病变的情况下，应考虑逆行使用Outback® Elite导管。
