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Complex Endovascular Strategies in the Treatment of Peripheral Arterial Disease – Challenging Arterial Approaches in Total Chronic Occlusions
I. Benedek1, Gabriela Kozma1, Monica Chitu1, I. Kovacs2, A. Sârbu2, Melinda Kurtinecz1, Claudia Matei1, Zsuzsanna Suciu2, Diana Horga1, Sz. Madaras2, Theodora Benedek2
1 Emergency County Hospital Tg Mureș, Cardiology Clinic
2 Medicine and Pharmacy University Tg Mureș, Discipline of Internal Medicine 6
Over the course of the last decade , in comparing the first set of TransAtlantic Inter- Society Consensus (TASC) guidelines to the second there was significant movement toward expanded management of a variety of peripheral disease morphologies—including occlusions—using endovascular techniques. With recent advances in technology many endovascular specialists routinely consider minimally invasive options for TASC C and TASC D lesions as well.This minimally invasive procedure carries a lower morbidity and mortality and shorter hospital stay compared with surgery and should be the first treatment option in all patients who would otherwise be offered bypass surgery or amputation, as failure rarely precludes surgery. When antegrade recanalization fails or is not feasible other approaches to endovascular recanalization can be explored. In this article we describe three cases of successful recanalisation of complex lesions involving total occlusions of the distal aorta, iliac arteries or infrainguinal vessels via retrograde arterial access through popliteal or posterior tibial arteries, alone or in combination with other vascular approaches in patients without other revascularization alternatives or with high surgical risk.