A 75-year-old diabetic female presented with resting pain in her left foot. Her resting ankle-brachial indexes were 1.25 on the left and 1.22 on the right. We accessed the right groin and passed an Omni catheter (AngioDynamics) to access the contralateral common femoral artery. An angiogram revealed that the common femoral, deep femoral, and superficial femoral were patent, but the popliteal was 100% occluded. We utilized the 0.014″ Command wire (Abbott Vascular), and after the extension was passed, inflated the CrossLock balloon. With the balloon inflated, we crossed the total occlusion and passed the wire into the peroneal vessel. Through the CrossLock, we then performed a kissing-balloon technique with a 3.5 mm Chocolate balloon (Cordis Corporation) and a 4.0 mm Chocolate balloon in the peroneal. We individually stented the anterior tibial artery with a 3.5 x 28 mm Alpine stent (Abbott Vascular) and a 4.0 x 23 mm Alpine stent in the peroneal artery. Angiography confirmed excellent patency of the popliteal, peroneal, and anterior tibial with two-vessel run-off. The CrossLock has a distinct advantage of keeping one central in the lumen and also has very firm support to allow passage of a balloon catheter or other device.
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