Success for Complex Peripheral CTO Hybrid Radial and
Success for Complex Peripheral CTO: Hybrid Radial and Tibia Pedal Access Wah Htun, FACC, FSCAI Gundersen Health System
Wah Htun, MD I have no relevant financial relationships Thanks to Tibio pedal Working group led by Dr. Tak Kwan.
AHA Statistical Update Heart Disease and Stroke Statistics— 2019 Update ▶ Endovascular interventions of CLI are being used with greater frequency nowadays. From 2003 to 2011, there was a significant increase in endovascular intervention of patients with CLI from 5. 1% to 11. 0%, which was accompanied by lower rates of in-hospital mortality and major amputation, as well as shorter length of stay. Chapter 23: Peripheral Artery Disease and Aortic Diseases Matsushita K, Kwan T. Circulation 2019; 139: e 456
Transradial Transpedal Dual Transradial-Transpedal Figure: Crossing and Procedural Success Rates for Transpedal versus Transradial Approach for Treatment of Superficial Femoral Artery (SFA) Chronic Total Occlusion (CTO),
Radial access is mainly used for -road mapping ( especially CTO is in prox SFA, not to get re entry at CFA or iliac) -for CART approach in case of long CTO with failure to get through tibio pedal approach
after Peroneal Artery Access Occluded peroneal artery Baseline Pedal Pressure 55 mm. Hg
Retrograde 0. 018” Gold Glidewire inside microcatheter into Subintimal and CART Antegrade wire Knuckled Retrograde wire Retrograde balloon
Popliteal Peronea artery Prox SFA Mid SFA PTA
Pedal Hemodynamics Baseline Pedal Pressure 55 mm. Hg PBI 0. 56 Final Pedal Pressure 116 mm. Hg PBI 1. 15
• Early discharge • Improved patient comfort • Reduce vascular complications Radial Pedal
Conclusion • SFA-CTO intervention with hybrid tibio pedal and transradial ( left ) ss feasible and safe using TR, TP, dual TR-TP – Early discharge – Early ambulation – Patient satisfaction – Réduction in vascular complications
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