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Date of download: 6/22/2016 Copyright © The American College of Cardiology. All rights reserved. From: A Novel Modification of the Retrograde Approach.

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Volume 32, Pages 14-17 (January 2016) A Novel Hybrid Viabahn-assisted Bypass Technique: Extra-arterial Flossing Wiring for Chronic Total Occlusion in Superficial Femoral Artery T.C. Lin, P.L. Chen, I.M. Chen EJVES Short Reports Volume 32, Pages 14-17 (January 2016) DOI: 10.1016/j.ejvssr.2016.04.003 Copyright © 2016 The Authors Terms and Conditions

Figure 1 Viabahn-assisted bypass technique with open SAFARI and covered stent implantation. (A) After a small incision was made and an arteriotomy carried out, the guidewire and supporting catheter from the antegrade and retrograde access were all retrieved. The white arrow depicts the guidewire and supporting catheter retrogradely from distal artery, and the white dotted arrow depicts the guidewire and supporting catheter antegradely from proximal artery. (B) The white arrow shows the retrograde guidewire being inserted into the antegrade catheter manually. (C) The flossing stiff guidewire (white arrow) was established and it crosses the arteriotomy incision. (D) A covered stent (white arrow) was then deployed to cover the lesion, and should be positioned across the arteriotomy. SAFARI = subintimal arterial flossing antegrade and retrograde intervention. EJVES Short Reports 2016 32, 14-17DOI: (10.1016/j.ejvssr.2016.04.003) Copyright © 2016 The Authors Terms and Conditions

Figure 2 Angiography. (A) Pre-operative angiography showing a superficial femoral artery chronic total occlusion. The antegrade wiring (white arrow) could not pass through the lesion. (B) Pre-operative angiography showing acceptable distal runoff. (C) After the Viabahn-assisted bypass technique, post-balloon dilatation was performed. (D) Final angiography showing optimal revascularization. EJVES Short Reports 2016 32, 14-17DOI: (10.1016/j.ejvssr.2016.04.003) Copyright © 2016 The Authors Terms and Conditions

Figure 3 (A) Schematic diagram of Viabahn-assisted bypass. (B) A post-procedural CT scan revealed the stent graft (arrow) outside the native superficial femoral artery (arrowhead). EJVES Short Reports 2016 32, 14-17DOI: (10.1016/j.ejvssr.2016.04.003) Copyright © 2016 The Authors Terms and Conditions