1. BEC 2011
BTK case
K. Deloose
M. Bosiers

2. Patient presentation Demographics Risk Factors Current medication
Gender : male
Age : 78 years
Race : White/Caucasian
Length : 172 cm
Weight : 80 kg
Risk Factors
Hypertension (under medication)
Hypercholesterolemia
Current medication
Bisoprolol, Zestril, Lipitor, Ezetrol, Cardegic, Persantine

3. Patient presentation Clinical presentation
Intermittent Claudication right leg, Rutherford III
Ankle brachial index
Right : 0.65
Left : 0.88
MR angiography 

4. Contralateral femoral retrograde access
Cross-over procedure
Cook 5F RIM catheter
Terumo 0.035” guidewire, bent, stiff
Exchange to
Terumo 6F Destination sheath, 45cm long

5. Coral reef occlusion
Distal femoral – proximal popliteal artery

6. Attempts to pass the occlusion Intraluminal / subintimal
Terumo 0.035” guidewire, bent
Terumo 0.035” guidewire, straight
4F Berenstein catheter
Abbott 5/80 Fox balloon
 unsuccessful

7. Retrograde access Duplex-guided Via anterior tibial artery
Cook micropuncture set

8. Micropuncture set

9. Retrograde access
Advancement of Boston Scientific 0.018” V18 guidewire
Anterior tibial artery

10. Retrograde access
Advancement of Boston Scientific 0.018” V18 guidewire
Popliteal artery

11. Retrograde access
Advancement of Boston Scientific 0.018” V18 guidewire
Distal femoral artery
Support of CXI support catheter (Cook)

12. Retrograde access
Steering of the Boston Scientific 0.018” V18 guidewire into the 5F Berenstein catheter

13. Guidewire exchange
Exchange of the retrograde Boston Scientific 0.018” V18 guidewire into anterograde position with the Cook CXI 0.018” support catheter
Predilation with Biotronik 3.5/170mm Passeo-18 balloon

14. Stenting & Final result
Exchange Boston Scientific 0.018” V18 guidewire to a straight, stiff Terumo wire
Stenting:
ev3 6.0/200mm Everflex stent
ev3 6.0/100mm Everflex stent
Post-dilation:
Ev3 4.0/100mm Evercross balloon
 Final angiographic result proximal

15. Final result
Final angiographic result distal

16. Distal puncture site control
Control of anterior tibial puncture site, post manual compression