Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 57 years-old man with a history of hypertension, DM and hemodialysis admitted to our hospital complaining Rt. His 2nd toe discoloration with resting pain, a Rutherford classification of grade 5-6. He was given aspirin, cilostazole and atorvastatin. His right ankle brachial idex(ABI) was 1.31 and left ABI was uncheckable.
Relevant test results prior to catheterization
Lower extremity artery CT angiography showed that his right common iliac artery to popliteal artery were patent and his right anterier tibial artery was CTO with severe calcification.
Relevant catheterization findings
His right lower extremity angioraphic findings were same result above CT.
1) Approach : Rt.femoral approach
2) Sheath : 6Fr Ansel sheath
3) GW : Antegrade approach : CXI support catheter(2.6Fr) .018 system / Rubicon + .014 Abbbott Hi-torque command, .014 Asahi Astato XS 20, .014 Boston V-14, Gaia second è wiring fail d/t dense calcium
4) Retrogradeapproach : Rt. dorsalis pedis puncture è CXI support catheter (2.6Fr).018 +.014 Boston V-14, .014 Asahi Astato XS 20
5) Rendezvous : ATA distal portion (Reverse CART technique, Ryujin Balloon 1.0*10 backup, Retrograde wiring by Astato .014
6) Change wire : .014 Asahi Regalia XS 1.0
7) Balloon angioplasty
.014 Boston Coyote 1.5 mm-40 mm up to 14 atm
.018 cordis savvy 2.0 mm-40 mm èperforation
Ryujin 1.5 x 20 mm up to 14 atm è perforation
.014 ev3 NanoCross 2.0 mm-15 mm up to 14 atm
.014 ev3 NanoCross 3.0 mm-25 mm up to 14 atm
6) Angiography : ATA mid portion hard calcium
7) Balloon angioplasty SAPPHIRE NC Balloon 3.0 x 15 mm up to 22 atm è No reflow due to dissection
.035 boston mustang 3.0 mm-20 mm up to 14 atm
8) Final angiograph : Patent ATA flow
We successfully treated TAST D lesion CTO of ATA with retrograde approach via distal channels from dorsalis pedis artery using reverse CART technique. This novel method is possibly one of the efficient techniques in endovascular treatment to CTO of BTK.