Post-Angioplasty Dissection Management: Bailout Strategies
After PTA, a dissection doesn't always mean immediate stenting. Learn the practical rules for managing femoro-popliteal dissections without turning a focal problem into a metal sentence.
After PTA, a dissection doesn't always mean immediate stenting. Learn the practical rules for managing femoro-popliteal dissections without turning a focal problem into a metal sentence.
Once the decision is made to go subintimal, the technique becomes a matter of discipline: keeping the loop small, advancing the catheter behind the wire, and re-entering the true lumen right at the distal cap - the most demanding step of the entire procedure.
Once the Target Arterial Path is chosen, the technical question becomes how to cross the CTO. In long femoropopliteal occlusions the relationship between intraluminal and subintimal recanalization is more nuanced than the textbook sequence suggests — three scenarios worth distinguishing.
Before discussing how to cross a long or multilevel CTO, we need a more fundamental question: which vessel do we recanalize? The strategic framework of the 2019 Global Vascular Guidelines — Target Arterial Path, GLASS, and the role of the angiosome — defines everything that follows.
Heavy calcification is not just a technical obstacle — it changes the rules of the game entirely. In this issue: why the subintimal approach often fails in the highly calcified pattern, and why staying endoluminal is both the harder and the smarter choice