Recanalization of TASC C/D Iliac Occlusion: An Improved Technique through the Radio-brachial Access

Abstract

We describe a technique for reanalyzing total chronic long occlusion of the iliac arteries (TASC/D) through the radio-brachial approach. After having obtained the arterial  approach, a 6F 90cm long Shuttle sheath (Cook Group, Bloomington, IN, USA) or a 4F 100cm Fortress sheath (Biotronik AG, Bulack, Switzerland) has been inserted into the left radial or brachial artery reaching the distal aorta, where an injection through the catheter has been made to assess the proximal occlusion cap. A 125 long MPA 4 or 5F catheter has been advanced over a coronary. 014” CTO guide-wire. The coronary guide-wire has been replaced with a Terumo guide-wire leaving the catheter into the first 4-5cm to the occlusion and a subintimal recanalization of the distal portion of the occlusion has been accomplished. Balloon dilation and implantation of long or multiple self-expandable stent have been accomplished to obtain patency of the vessels. The described technique appeared to be simple and safe allowing for recanalization of long iliac segments independently from the access, femoral or radial/brachial used. Large studies with long follow up are warranted to assess long-term effectiveness.