Korean J Radiol.  2010 Aug;11(4):441-448. 10.3348/kjr.2010.11.4.441.

An Effective Guidewire Looping Technique for the Recanalization of Occlusive Segments of Infrapopliteal Vessels

• Wang JB
• Zhao JG
• Li MH
• Zhu YQ
• Wang J
• Zhang PL

• KMID: 984898
• DOI: http://doi.org/10.3348/kjr.2010.11.4.441

Abstract

OBJECTIVE
To determine the efficacy, safety and primary follow-up results of a guidewire looping technique for the treatment of infrapopliteal arteries.
MATERIALS AND METHODS
From October 2006 to May 2008, an intraluminal angioplasty of the infrapopliteal arteries was attempted in 200 consecutive patients. Altogether, 417 infrapopliteal lesions, with lengths varying from 2 cm to 32 cm, were treated as part of this study, including 305 lesions in the anterior tibial arteries, 89 in the posterior tibial arteries, and 23 in the peroneal arteries. The 'U'-shaped guidewire technique was attempted in 393 lesions from 361 limbs. The tip of a hydrophilic 0.035-inch guidewire was formed into a 'U' shape with the aid of a 4-Fr catheter and collateral branch vessel to recanalize the completely occluded long segment lesions.
RESULTS
A successful angioplasty with at least one artery recanalized directly to the malleolar or dorsal foot was achieved in 322 limbs (89%). The looping technique had a success rate of 90% (352 of 393 lesions). After the procedure, the rest pain was relieved in 58 of 69 patients, while 207 of 245 limbs (85%) showed improvement for intermittent claudication. Complete wound healing was noted in 21 of 54 patients, while 20 of 54 patients showed an improvement in the wound size or depth. A total of 38 major immediate procedure-related complications were noted, including retroperitoneal hematoma, distal emboli, and vessel rupture.
CONCLUSION
The results of this study suggests that the guidewire looping technique is a safe and effective method for the recanalization of the occluded lesions in infrapopliteal vessels.

Keyword

Infrapopliteal arteries; Loop technique; Limb ischemia; Angioplasty

MeSH Terms

Aged
Aged, 80 and over
Angioplasty/*methods
Ankle Brachial Index
Arterial Occlusive Diseases/*surgery
Female
Follow-Up Studies
Foot/blood supply/surgery
Humans
*Magnetic Resonance Angiography
Male
Middle Aged
*Popliteal Artery
Postoperative Complications
Treatment Outcome

Figure

• 

  Fig. 1 Diagrams showing transluminal angioplasty technique. A. We first inserted hydrophilic guidewire into proximal branch and then made 'U' shape loop by rotating and advancing guidewire continually. B, C. Loop guidewire was advanced into and over occlusive segment of vessel. D. Catheter was crossed over occlusive segment along guidewire.

• 

  Fig. 2 67-year-old man with more than 10-year history of diabetes mellitus presented with symptoms of limb ischemia. A, B. Lateral lower limb angiogram revealed long segment of occlusive disease in anterior tibial artery along more than 15 cm, with faint run-off tract (arrow). C. Plain film showed head of hydrophilic guidewire (arrow) forming loop when passing through occlusive segment through 4-Fr vertebral catheter. D. Fluoroscopic angiogram demonstrated run-off tract indicating true lumen process. E, F. Immediate angiogram performed post-procedure showed restoration of anterior tibial artery with straight-line flow to pedal arch. Residual stenosis was less than 30% (arrows).

• 

  Fig. 3 69-year-old women with 15-year history of diabetes mellitus presented with gangrene in three to five toes of her right foot. A, B. Lateral lower limb angiograms reveals long segment of occlusive disease in anterior (arrow) and posterior tibial arteries. C, D. Plain films shows head of hydrophilic guidewire forming loop and passing through occluded segment with 4-Fr vertebral catheter and long balloon dilation of recanalized artery. E, F. Immediate angiograms performed post-procedure show restoration (arrow) of anterior tibial artery, but distal dorsal artery was embolized and subsequent thrombolysis did not work. Patient ultimately underwent below ankle amputation.

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