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BackTable / VI / Podcast / Episode #260

SAFARI Procedure

with Dr. Luke Wilkins

In this episode, host Dr. Ally Baheti interviews interventional radiologist Dr. Luke Wilkins about his approach to the subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) technique for crossing challenging chronic total occlusions (CTO) in critical limb ischemia (CLI) patients.

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SAFARI Procedure with Dr. Luke Wilkins on the BackTable VI Podcast)
Ep 260 SAFARI Procedure with Dr. Luke Wilkins
00:00 / 01:04

BackTable, LLC (Producer). (2022, November 11). Ep. 260 – SAFARI Procedure [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Luke Wilkins discusses SAFARI Procedure on the BackTable 260 Podcast

Dr. Luke Wilkins

Dr. Luke Wilkins is a practicing interventional radiologist at University of Virginia VIR.

Dr. Aparna Baheti discusses SAFARI Procedure on the BackTable 260 Podcast

Dr. Aparna Baheti

Dr. Aparna Baheti is a practicing Interventional Radiologist in Tacoma, Washington.

Synopsis

Dr. WIlkins gives us the basic indication for the procedure, which is when the lesion is unable to be crossed from a purely antegrade approach and other re-entry devices have failed. Dr. Wilkins will always attempt to use an Outback wire and an Enteer balloon before performing the SAFARI technique. There are multiple factors that influence the decision to use SAFARI, such as lesion location, level of calcification, and size of the true lumen at the re-entry point.

Next, Dr. Wilkins walks us through a typical SAFARI. He normally establishes retrograde access in the dorsalis pedis or posterior tibial artery using a 4 cm micropuncture needle and an exchange length Nitrex wire. He uses telescoping catheters from the antegrade direction. When the antegrade and retrograde approaches enter the same subintimal plane, the 2 devices can connect and the lesion can be crossed. If it is challenging to achieve the same intimal plane for both devices, the gunsight approach of overlapping snares can be utilized. After the lesion is crossed, normal angioplasty and stenting can occur.

Dr. Wilkins gives advice on how to make the procedure efficient. In occlusions that are longer than 1 cm, he always makes sure that the foot is prepped before the case starts. He also emphasizes the importance of knowing when to try a different technique and notes that this intuition comes from experience.

Finally, we discuss patency rates for SAFARI patients, which have been relatively high. This technique has made a large impact on limb salvage in a patient population that previously had no other non-surgical options.

Resources

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Topics

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Critical Limb Ischemia (CLI) Condition Overview

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