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Hydrodynamic boost: a novel re-entry technique in subintimal angioplasty of below-the-knee vessels

  • Vascular-Interventional
  • Published:
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Abstract

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.

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Acknowledgements

The scientific guarantor of this publication is Roberto Ferraresi. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Peripheral Interventional Unit, Humanitas Gavazzeni, Via Mauro Gavazzeni, 21, Bergamo, Italy

    Roberto Ferraresi

  2. Unit of Vascular Surgery, Humanitas Gavazzeni, Via Mauro Gavazzeni, 21, Bergamo, Italy

    Meneme Hamade & Vito Gallicchio

  3. Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, P.zza Santa Maria Nuova, 1, Florence, Italy

    Nicola Troisi

  4. Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, , P.zza Edmondo Malan 1, Italy

    Giovanni Mauri

Authors
  1. Roberto Ferraresi
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  2. Meneme Hamade
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  3. Vito Gallicchio
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  4. Nicola Troisi
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  5. Giovanni Mauri
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Corresponding author

Correspondence to Roberto Ferraresi.

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Ferraresi, R., Hamade, M., Gallicchio, V. et al. Hydrodynamic boost: a novel re-entry technique in subintimal angioplasty of below-the-knee vessels. Eur Radiol 26, 2419–2425 (2016). https://doi.org/10.1007/s00330-015-4078-4

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  • DOI: https://doi.org/10.1007/s00330-015-4078-4

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