Arterial Revascularization

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• Peripheral vascular disease - including focal or long segment stenoses and/or chronic total occlusions.

• Uncorrectable bleeding diathesis
• Stenotic/occlusive disease with high thromboembolic risk
• Renal failure
• Extreme vessel tortuosity

Things to check:
• History and Physical
• Patient anticoagulation status
• Creatinine, coagulation profile
• Any prior imaging - Vascular ultrasound, CTA, MRA
• Lower extremity pulses


Procedural steps:
• Access common femoral artery of contralateral leg using micropuncture needle under US
• Advance wire centrally
• Place a 5, 6 or 7 Fr sheath (depending on the potential atherectomy device).

• Advance flush catheter over the wire into the aorta.
• Perform AP aortogram - 15 mL/sec for 30 mL.
• Pull flush catheter back into the distal aorta
• Perform iliac artery arteriogram - 10 mL/sec for 20 sec.
• Keep catheter in distal aorta and perform lower extremity runoff arteriography - 8 mL/sec for 80 mL

Evaluate lesion(s)
• Exchange for a selective catheter and catheterize target artery.
• Position catheter proximal to lesion.
• Administer heparin bolus prior to crossing lesion (2500-5000 U)
• Gently advance guidewire across stenosis.
• If resistance is met - avoid dissection and retract wire. Redirect catheter and readvance wire until successful passage.
• Direct guidewire through central canal of lesion. Advance selective catheter over wire across the lesion
• Angiogram following lesion crossing to confirm position
• Exchange crossing guidewire for a 0.014" guidewire.

• Many options from balloon angioplasty to atherectomy
• Introduce atherectomy device over guidewire; perform atherectomy across lesion
• Inject contrast through sheath or catheter to evaluate progress. Determine if further intervention is needed. May need balloon angioplasty, or stent placement if dissection occurs.
• Remove access sheath and close arteriotomy site - closure device or manual pressure.


Obtain hemostasis
• Supine bedrest for 3 hours with closure device. 6 hours with manual pressure

• Arterial injury - dissection, rupture, hematoma, distal embolization, thrombosis.
• Groin complications

Related Procedures

No related procedures.



[1] Mittleider D, Russell E. Peripheral Atherectomy: Applications and Techniques. Tech Vasc Interv Radiol. 2016;19(2):123‐135. doi:10.1053/j.tvir.2016.04.005
[2] Wilkins LR, Sabri SS. Strategies to Approaching Lower Limb Occlusions. Tech Vasc Interv Radiol. 2016;19(2):136‐144. doi:10.1053/j.tvir.2016.04.006
[3] BackTable, LLC (Producer). (2017, August 16). Ep 9 - #StopTheChop [Audio podcast]. Retrieved from

Join The Discussion



Demos are not yet available for this procedure.

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Atherectomy of Common Femoral and Superficial Femoral Arteries

Dr. Chris Metzger performs atherectomy of the common femoral and superficial femoral arteries.

Complex Revascularization of SFA Occlusion Using Rotational Atherectomy

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CO2 Angiography

Dr. Craig Walker demonstrates CO2 angiography and discusses the advantages of this imaging technique. He then shows the tools and technique to image an iliac artery.

Critical Limb Ischemia and Left Foot Ulcer

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Complex Below-the-Knee Revascularization by Dr. Scott Brannan

Dr. Scott Brannan demonstrates wire escalation strategies, intravascular ultrasound, and rotational atherectomy to achieve revascularization in complex BTK disease

Let's Talk IVUS and PAD

This presentation gives viewers an overview of IVUS as well as its applications and benefits related to PAD interventions.



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Literature is not yet available for this procedure.

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Seminars in Interventional Radiology (Dec 2014)

Overview of Classification Systems in Peripheral Artery Disease

A review of the various classification systems for the diagnosis and treatment of PAD and advantages of each system.



Podcasts are not yet available for this procedure.

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#StopTheChop Podcast Guest Dr. Kumar Madassery

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Dr. Kumar Madassery and Dr. Sabeen Dhand discuss their PAD practices and the story behind the #stopthechop hashtag.


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Dr. Mike Watts and Dr. Omar Saleh discussing the ins and outs of treating PAD in the Outpatient Based Lab (OBL) setting.


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Dr. Jim Melton and Dr. Blake Parsons discuss the benefits of retrograde pedal access in the treatment of PAD, as well as the multi-disciplinary team approach of their outpatient CardioVascular Health Clinic.


Building a PAD Practice BackTable Podcast Guest Dr. Srini Tummala

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Dr. Srini Tummala talks us through how he successfully built a thriving PAD practice alongside Vascular Surgery and Interventional Cardiology.


Pedal Acceleration Time for Limb Salvage BackTable Podcast Guest Jill Sommerset

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Building a Limb Salvage Program Podcast Guest Dr. Jihad Mustapha

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CLI fighters Dr. Jihad Mustapha and Dr. Sabeen Dhand building a Limb Salvage program, including broadening skill sets such as pedal access, and meticulous patient follow up.



Blog Articles

Blog articles are not yet available for this procedure.

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Building a Multidisciplinary Limb Salvage Program

Defining limb salvage for critical limb ischemia treatment and building a successful limb salvage program with a multidisciplinary approach .


Taking a Multidisciplinary Approach to Peripheral Arterial Disease

From podiatry to interventional radiology, peripheral arterial disease (PAD) is managed by numerous medical specialties. A multidisciplinary approach to trea...


Access Points and End Points in Peripheral Arterial Disease

Vascular access decisions should be tailored to the location of disease burden in patients with peripheral arterial disease. PAD experts Dr. Sabeen Dhand and...


Challenges and Evolutions in Limb Salvage

Challenges with building a limb salvage program and advances in tibial-pedal access and extravascular ultrasound for optimal CTO crossing.


Intraoperative Management of Peripheral Arterial Disease

Anesthesia choice and intraprocedural anticoagulation are critical for optimal patient outcomes, and IRs have some options when it comes to management during...


Imaging to Atherectomy: Technologies to Identify and Treat Peripheral Arterial Disease

There are numerous modalities available to characterize and treat peripheral arterial disease (PAD). Dr. Kumar Madassery and Dr. Sabeen Dhand highlight their...