Author + information
- Received November 2, 2017
- Accepted November 7, 2017
- Published online January 17, 2018.
- Keisuke Nakabayashi, MD, PhD∗ (, )
- Nobuhito Kaneko, MD,
- Hiroshi Ando, MD, PhD and
- Minoru Shimizu, MD, PhD
- ↵∗Address for correspondence:
Dr. Keisuke Nakabayashi, Heart Center, Kasukabe Chuo General Hospital, 5-9-4 Midori-cho, Kasukabe City, Saitama 344-0063, Japan.
A 61-year-old man with end-stage renal disease presented to receive endovascular therapy for bilateral intermittent claudication. The target lesion was located in the right common femoral artery and superficial femoral artery. We inserted a 6-F guiding sheath from the left common femoral artery. However, we could not cross over the aortic bifurcation with the balloon anchoring technique because of a severely angled and calcified aortoiliac lesion. Therefore, we progressed the snare catheter (EN Snare, Merit Medical Systems, South Jordan, Utah) through the guiding catheter and punctured the proximal right common artery to insert the 0.035-inch stiff wire (Radifocus Stiff, Terumo, Tokyo, Japan) (Figure 1A). The snare catheter caught the 0.035-inch stiff wire (Figure 1B, Online Video 1) and established wire externalization (Figure 1C). The crossover was completed with high back-up force (Figure 1D, Online Video 2).
A severely angled and calcified aortic bifurcation can complicate the strategy for endovascular therapy (1). The 0.035-inch wire externalization technique described herein might be a last resort to overcome such a complication.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 2, 2017.
- Accepted November 7, 2017.
- 2018 American College of Cardiology Foundation