[MO-1] EVT for re-occlusion BK lesion by trans invisible collateral approach
A 7x-year-old man was admitted to our hospital because of critical limb ischemia three months ago. He had 1st toe ulcer. His SPP was 18mmHg at the inside of planter. Angiography showed total occlusion of anterior tibial artery (ATA) and posterior tibial artery. We attempted EVT for left ATA CTO by left femoral access. We could not advance the treasure XS12 wire to distal true lumen. Left dorsal artery had severe stenosis and the length of puncture site was short. But we successfully punctured dorsal artery. We inserted the micro catheter retrogradely. We could pass the lesion and advance the Jupiter FC3 wire into the antegrade micro catheter. We performed balloon angioplasty. Final angiography showed good wound blush. After this EVT, his ulcer was getting better. But small ulcer remained after 3months. We attempted re-EVT. Angiography showed left ATA was re-occluded and left dorsal artery was disappeared. We attempted EVT for left ATA CTO. We could advance the treasure XS12 wire by IVUS guide. But we could not advance the wire to dorsal artery. It was difficult to puncture dorsal artery again, because we could not detect dorsal artery by angiography. We checked first angiography again. First angiography showed collateral flow from distal peroneal artery to dorsal artery. So, we advanced the micro catheter to distal peroneal artery. We performed tip injection via micro catheter. But, we could not detect collateral flow. There was probably collateral artery from peroneal artery to dorsal artery. We tried to advanced the vassalo wire through invisible collateral artery and successfully conduct trans invisible collateral approach. We could pass the lesion and advance the Jupiter X wire into the antegrade micro catheter. We performed balloon angioplasty. Final angiography showed good wound blush. After this EVT, his ulcer had healed.