ABSTRACT
Crossing occlusions is more challenging and less reproducible than crossing stenotic lesions. The only reason to cross an occlusion is in preparation for an attempt at recanalization. Visceral and renal artery occlusions are often spillover lesions of aortic plaque occluding the entry of the branch artery. For renal lesions, this is usually an ipsilateral anterior oblique projection. The other key issue regarding infrarenal aortic occlusion is to assess how far distally the occlusion extends. In general, aggressive subintimal approaches in the infrarenal aorta should be avoided until further studies have been undertaken. Popliteal artery occlusions are often shorter than superior femoral artery occlusions because of the short length of the popliteal artery. Tibial artery occlusions are usually best to cross in the intraluminal space. External anatomic manipulation can be performed in order to move the orientation of an artery to obtain a better arteriogram or to pass guidewires or devices.
