Published in:
01-08-2016 | Vascular-Interventional
Hydrodynamic boost: a novel re-entry technique in subintimal angioplasty of below-the-knee vessels
Published in: European Radiology | Issue 8/2016
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Objectives
To describe the hydrodynamic boost (HB) technique and report our preliminary results with this technique in the subintimal angioplasty of below-the-knee vessels.
Methods
HB was used in 23 cases (14 males, mean age 73 ± 12 years) of critical limb ischemia, with long chronic total occlusion of tibial arteries extended to the ankle level. The operator performs a manual injection of diluted contrast dye through a 4 F catheter into the subintimal space, close to the patent true distal lumen, in order to achieve a tear in the intimal flap and a connection with the true lumen.
Results
In 19/23 (83 %) cases, the HB was effective in creating a connection between the subintimal space and the true distal lumen and it was possible to advance a wire and to conclude the procedure. In 4/23 (17 %) lesions, the HB failed and the procedure was successfully completed by retrograde approach. No major complications occurred. Mean length between catheter tip and re-entry point was 8 ± 5 mm.
Conclusions
HB seems to be a feasible, safe and effective re-entry technique in distal below-the-knee vessels. This method represents an easy option for re-entry that extends the possibility of antegrade approach to obtain a successful revascularization.
Key points
• In subintimal angioplasty of below-the-knee vessel re-entry can represent a challenge.
• Inability to re-enter may determine the failure of the revascularization procedure.
• HB is a novel re-entry technique feasible in distal below-the-knee vessels.
• HB may increase the success rate of antegrade approach.
• In case of failure, retrograde approach remains feasible.