ABSTRACT
Once total occlusions are revascularized, final angiography should include the distal vasculature, since distal atheroembolization from these bulky plaques may occur and require management. Tortuous and calcified vessels in the periphery can make peripheral Chronic total occlusion (CTO) revascularization extremely difficult. In these patients, the standard wire and catheter technique can fail due to poor guide support, poor wire support, and inability to re-enter the true lumen secondary to calcification. The most common technical approach for crossing CTOs in the periphery involves using a supportive crossing catheter with a hydrophilic 0.035 inch wire. Once the lesion can been crossed, a decision for revascularization technique must be made. Although stenting has been demonstrated to improve short-term patency in the superficial femoral artery, issues around stent fracture and in-stent restenosis drive operators to alternative strategies. Once the lesion can been crossed, a decision for revascularization technique must be made.
