Feasibility and Safety of the Direct Occluded Vessel Puncture Technique as a New Access Site for Complex Peripheral Artery Occlusive Disease

Abstract

This study aims to describe the feasibility and safety of direct occluded vessel puncture as a new access site for complex peripheral artery occlusive disease.Methods: Eleven consecutive patients with symptomatic peripheral artery disease underwent endovascular therapy using the direct occluded vessel puncture technique. The occluded vessel was punctured using a dedicated 20 G needle and the Hi-Torque Command 18 ST guidewire under duplex echo or fluoroscopic guidance, and a 6 Fr sheath was then inserted. Hemostasis was achieved with the Exoseal ® Vascular Closure Device.Results: Direct occluded vessel puncture was achieved in 10 of 11 cases (90.9%), and procedural success was achieved in all cases. There were no in-hospital deaths or any complications, including bleeding, pseudoaneurysms, thrombosis, or surgical conversion. Conclusion:The direct occluded vessel puncture technique using a 20 G needle and the Hi-Torque Command 18 ST is feasible and safe. This technique may also be used as an alternative option when there are no appropriate approach sites. AimThis study was conducted to evaluate the feasibility and safety of the direct occluded vessel puncture technique in the creation of a new access site for complex PAOD. Methods Patient PopulationA total of 82 symptomatic patients with aortoiliac and/or femoropopliteal chronic total occlusion (CTO) underwent endovascular therapy (EVT) in our hospital between August 2019 and February 2020. Direct occluded vessel puncture was attempted in 11 patients (5 men; mean age: 74.8 8.4 years) to recanalize the complex CTO lesion after unsuccessful standard antegrade recanalization because there was no Copyright©2021 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

Intravascular ultrasound findings of the protrusion of the EXOSEAL plug that caused acute limb ischemia

“… 1 , 2 Another report demonstrated that the EXOSEAL can be safely used for antegrade direct puncture of the patent SFA with ultrasound or fluoroscopic guidance. 3 Recently, Kawasaki et al 4 reported the use of the EXOSEAL for the occluded SFA, which required confirmation of the extravascular position of the indicator wire by fluoroscopy at the plug deployment. In our case, we accessed the femoral artery by palpation-guided puncture, and we did not notice the unintentional puncture of the proximal SFA.…”

Direct puncture of an occluded common femoral artery as a new approach for endovascular aortic aneurysm repair

“…Direct puncture of the occluded CFA could be an effective alternative measure to deal with this situation. Kawasaki et al reported on the efficacy of puncturing occluded vessels for peripheral vascular interventions (Kawasaki et al 2021 ). While ultrasound guidance was used in the present case for the vessel puncture, the puncture can be performed under fluoroscopy in a case of heavily calcified wall (Kawasaki et al 2021 ).…”