![]() Retrograde recanalization in BTK arteries can be performed through multiple different access sites. ![]() ![]() Retrograde percutaneous puncture: Considered when antegrade recanalization fails, this technical strategy consists of a retrograde percutaneous puncture of the distal patent vessel followed by retrograde wiring with the objective to achieve patency of the proximal lumen of the target artery. In foot vessels, stenting is contraindicated due to the high burden of mechanical trauma that can collapse and break the stent structure. It is essential to emphasize that direct blood flow through one tibial artery (ATA or PTA) with a good distal distribution system into the foot vessels can be a satisfactory and conclusive result of revascularization for the majority of the patients. īefore applying the loop technique, the operator must carefully analyze the vascular anatomy of the foot network. It is based on the wiring and balloon tracking through the plantar arch and creating a loop from the dorsal to the plantar circulation of the foot (or vice versa). Pedal-plantar loop technique: The goal is to restore direct arterial inflow from both principal circulatory pathways of the foot, achieving complete BTK revascularization, but this technique can also be used to succeed in wound-related artery recanalization, crossing through the opposite patent circulatory pathway to obtain retrograde recanalization of the occluded foot vessel. ![]() However, conclusive evidence on this is still lacking. Thereby, tissue perfusion may be improved for a longer period, increasing the potential for ulcer healing. It is also a viable solution to the problem of restenosis of the infrapopliteal arteries aiming in producing a more sustained clinical benefit. The idea behind DEBs and DESs is that by delivering drugs such as paclitaxel or sirolimus, neointima formation will be inhibited and the occurrence of restenosis reduced producing a more sustained clinical benefit. The use of bare stent (BS) when bailout stenting is indicated is recommended, as drug-eluting stent (DES) in few studies show clinical benefit from DES over BS. The use of Drug-eluting baloons (DEBs), especially diabetic patients, may be beneficial, but high-quality and adequately powered trials focusing on clinical outcomes are needed before this strategy can be implemented into standard clinical care. PTA with optional bailout stenting for BTK arterial lesions in patients with CLI is still the preferred strategy. Marco Solcia, in Vascular Surgery, 2022 Digital subtraction angiography with anterograde puncture of common femoral artery The posterior tibial artery terminates by dividing into medial and lateral plantar arteries.Īntonio Rampoldi. The nerve takes a medial relationship initially and becomes posterior in the lower part of the leg. Throughout the course, the posterior tibial nerve runs alongside the artery. A pair of deep veins accompanies the artery as venae comitantes. At its termination, the artery lies midway between the medial malleolus and the medial tubercle of the calcaneus, among the tendons of the deep leg muscles and under the cover of the flexor retinaculum. For the rest of the course, the artery takes a superficial course. In the upper two thirds, the posterior tibial artery lies deep to the covering muscles. It descends in the posterior compartment, lying on posterior tibialis for most of its course and covered by gastrocnemius and soleus muscles. Posterior tibial artery is the direct continuation of the tibioperoneal trunk. Rich, in Current Therapy of Trauma and Surgical Critical Care, 2008 Posterior Tibial Artery
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