Infrapopliteal occlusions in patients with critical limb ischemia (CLI) are a challenge. The failure rate when taking the traditional, antegrade approach has been reported as high as nearly 40%.1 For such patients, amputation may be the only remaining alternative. A new revascularization technique—the retrograde approach—aims to give physicians another chance at limb salvage. In cases with complex popliteal or tibioperoneal occlusions in which an initial antegrade approach failed, Montero-Baker et al. reported an 86.3% success rate2 with the retrograde approach.
In the following video, Dr. Yazan Khatib, president of the First Coast Cardiovascular Institute in Jacksonville, Fla., describes a case in which he tries a retrograde approach following a failed antegrade approach:
CXI SUPPORT CATHETER ESSENTIAL PRESCRIBING INFORMATION
The CXI Support Catheter is intended for use in small vessel or superselective anatomy for diagnostic and interventional procedures, including peripheral use.
• Maximum recommended infusion pressure is 1,200 psi.
• Avoid introducing air or any other gas through the catheter into the vascular system.
• This product is intended for use by physicians trained and experienced in small vessel access and interventional procedures. Standard techniques for placement of percutaneous catheters should be employed.
• Catheter manipulation should only occur under fluoroscopy.
• If the catheter is used for infusion, reference the table of flow rates in the Device Description section of these Instructions for Use and ensure infusion pressure does not exceed the recommendations.
• The catheter should not be advanced into a vessel having a reference vessel diameter smaller than the catheter outer diameter.
• This catheter is designed and intended for one time use only. Do not re-sterilize and/or reuse.
• The catheter should not be advanced through an area of resistance unless the source of resistance is identified by fluoroscopy and appropriate steps are taken to reduce or remove the obstruction.
• This catheter should only be used by physicians qualified to perform percutaneous vascular interventions.
1. Söder HK, Manninen HI, Jaakkola P, et al. Prospective trial of infrapopliteal artery balloon angioplasty for critical limb ischemia: angiographic and clinical results. J Vasc Interv Radiol. 2000;11(8):1021-1031.
2. Montero-Baker M, Schmidt A, Bräunlich S, et al. Retrograde approach for complex popliteal and tibioperoneal occlusions. J Endovasc Ther. 2008;15(5):594-604.