Impact of a bidirectional approach via radial and popliteal arteries for the treatment of chronic total occlusion of lower limb artery: A case report

A 49-year-old man with poorly controlled diabetes was admitted to Kushiro Rosai Hospital, Hokkaido, Japan after scalding both feet with boiling water. Because of poor healing, he was assessed for peripheral arterial disease. Angiography revealed total occlusion of the right common and external iliac arteries, diffuse stenosis of the right superficial femoral artery, focal stenosis of the left common iliac artery and chronic total occlusion of the left superficial femoral artery. A staged procedure with bidirectional approach via the radial and popliteal arteries was attempted. During the procedures, the patient was in the prone position on the catheterization table, and bidirectional guidewire manipulation was performed. All of the lesions were successfully stented. The patient was not required to change positions during the procedure, which can be performed by a single operator. The bidirectional approach is effective in the setting of transcatheter treatment of chronic total occlusive disease.