New Catheter for Converting an Antegrade Puncture into a Retrograde Access and Vice Versa using a Single Arterial Puncture

New Catheter for Converting an Antegrade Puncture into a Retrograde Access and Vice Versa using a Single Arterial PunctureS. Habib1 and J. Sagoo2

1 Nottingham University Hospitals, Nottingham, UK educational grant from Terumo Europe2 Terumo Europe Interventional Systems, Leuven, Belgium employed at Terumo Europe

Purpose Reporting use of new catheter to convert an antegrade arterial puncture into retrograde access

Material and MethodsNew Terumo 4-Fr. angiographic catheter (40cm length) with 90O angled tip Seven patients with bilateral lower limb atherosclerotic arterial disease were treatedAfter treating first identified lesion, catheter introduced through sheath into CFA and rotated so angled distal tip faced opposite directionGuide wire and treatment devices advanced to treat lesions in opposite direction

ResultsMultiple arterial lesions in both legs treated via single CFA accessAll patients received treatment as day-case proceduresCatheter successfully used without complications

ConclusionNew catheter facilitates treatment of PAD using single arterial punctureCan also be used for SFA cannulation Clinical Summary

#Patients Diagnosis:Bilateral SFA lesions 4 patients Iliac and SFA stenosis 3 patients, and includingHigh origin left fem-pop graft stenosis with right iliac occlusion repeat patient Materials:19G angiographic needle 4-Fr. angiographic catheter (40cm length) with 90O angled tip4-Fr. / 5-Fr. / 6-Fr. introducer sheath with R/O tip 0.035 angled hydrophilic guide wireDrug eluting balloon + balloon mounted OTW stentVascular closure device Method:60O antegrade CFA puncture (lesions treated), catheter inserted into sheath OTW until angled tip visible in vessel, guide wire withdrawn into catheter tip and sheath retracted until R/O tip visible within vessel wallUnder fluoroscopic guidance, catheter retracted into sheath and rotated 180O Guide wire, catheter and sheath advanced retrograde, lesions treated and haemostasis achieved using closure device / manual compression

Clinical History and Imaging Procedure

#A: Fluoroscopy RAO of right leg CFA with guide wire advanced antegrade before redirection B: Angiogram showing 90O angled distal tip of catheter and guide wire located retrograde after redirection C: 30O RAO roadmap showing redirected guide wire - retrogradeClinical History and Imaging Procedure

RAO BeforeRedirectionRAO AfterRedirectionRAO Rt CFA

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Changing direction of catheterization in right leg CFA: from antegrade to retrogradeGuide wire redirected from antegrade to retrogradeClinical History and Imaging Procedure

SFA CannulationB: Catheter introduced into CFA with 90O angled distal tip facing SFA

SFA Lesion - comprised of flush long occlusion A: Fluoroscopy of right leg CFA puncture in order to treat SFA lesion with guide wire advanced into PFClinical History and Imaging Procedure

#Converting catheterization from antegrade into retrograde access can often be achieved using variety of angled catheters But, complications prevent rotation of distal tip into desired directionCalcified atherosclerotic plaquesDiameter of CFA (