‘‘Trans-Collateral’’ Angioplasty for a Challenging Chronic Total Occlusion of the Tibial Vessels

A novel approach to percutaneous revascularization in critical lower limb ischemia.

Massimiliano Fusaro, MD, Pierfrancesco Agostoni, MD, and Giuseppe Biondi-Zoccai, MD

Arterial revascularization by means of percutaneous transluminal angioplasty (PTA) is a mainstay in the management of patients with peripheral artery disease and critical limb ischemia (CLI). However, when employing standard approaches, PTA of below-the-knee arteries may fail in up to 20% of cases. In the present article, we report a novel interventional strategy, the “transcollateral” angioplasty approach, which we successfully employed in a patient with critical lower limb ischemia and a challenging total infrapopliteal occlusion. This technique may probably increase success rates of PTA in very challenging total occlusions of below-the-knee arteries (e.g., those lacking a proximal occlusion stump). The tips pertinent to this case are illustrated, including the need to accurately choose appropriate guidewires and balloons, and the identification of the most appropriate collateral pathway.

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