Percutaneous retrograde puncture of occluded common femoral artery combined with SAFARI for recanalization of iliac-femoral-BTK arterial occlusion

This report describes the recanalization of iliac-femoral-popliteal-below the knee super-long chronic total occlusion (CTO) in a patient with chronic limb-threatening ischemia. We attempted recanalization with the SAFARI technique but failed because the retrograde guidewire could not re-enter into the true lumen of the common iliac artery. Then we conducted an additional retrograde puncture of the occluded common femoral artery and created a “flossing”-type guidewire to achieve revascularization. We combined the techniques of SAFARI and retrograde puncture of the occluded common femoral artery, which may represent a new strategy for revascularizing such kind of challenging super-long CTO.