SA- SAFARI: Single Access SAFARI. A Novel Technique.
Presenter
Shadi Halabi, M.D., FSCAI, COMHS, Munster, IN
Shadi Halabi, M.D., FSCAI, COMHS, Munster, IN
Title
SA- SAFARI: Single Access SAFARI A Novel Technique
Introduction:
Critical limb ischemia is the most severe form of peripheral vascular disease. Revascularization is required for improving limb perfusion and limiting risk of amputation. In the following case, we describe a novel endovascular technique, termed single access SAFAR (SA-SAFARI).
Clinical Case
78-year-old male with history of diabetes, hypertension, coronary artery disease presented with a non-healing 1
st toe ulcer. Non-invasive studies revealed good in flow with occluded anterior tibial. The decision was made for urgent revascularization attempt. Antegrade US-guided access of the common femoral artery was obtained and a 6 French antegrade sheath was placed. A 0.035 support catheter with multiple 0.014 wires were used to cross the anterior tibial artery but failed, both were kept in popliteal artery. Distal anterior tibial and dorsal pedis were both occluded making retrograde access challenging. A 0.014 support catheter with a hydrophilic 0.014 wire were used to cross front the patent posterior tibial artery using the pedal loop into the occluded dorsalis pedis and anterior tibial artery. The 0.014 wire and support catheter were inserted into the 0.035 support catheter. Both wires were pulled. A long 0.014 wire was placed across the anterior tibial and dorsalis pedis occlusion across the pedal loop. Atherectomy and balloon angioplasty of the anterior tibial artery and dorsalis pedis artery was performed. Final results showed excellent directly into the 1
st toe.
Discussion
We present the first description of the SA-SAFARI technique. Direct in line flow to the wound has been increasingly shown to be associated with improved outcomes. The SAFARI technique, which is an established technique that is commonly used, has become an important pillar in the tool box of crossing challenging occlusion utilizing retrograde access. However, this retrograde pedal access requires time and expertise, especially when accessing occluded pedal vessels. The described single access (SA) SAFARI technique abolishes the need for a dedicated retrograde access, allowing for the utilization of a support catheter and enables the operator to apply therapy in an antegrade fashion; all using a single access point.