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BackTable / VI / Podcast / Episode #448

Below the Ankle Expertise: Distal Pedal Access

with Dr. Marta Lobato

In this episode, Dr. Marta Lobato explores advanced endovascular techniques in below the knee (BTK) and below the ankle (BTA) interventions for critical limb ischemia (CLI). She introduces various skills that were developed and used by her team, such as the telescopic needle, buddy needle, balloon-assisted puncture, and vasodilation to prevent artery spasm. Dr. Lobato is a vascular surgeon at Hospital de Cruces in Barakaldo, Spain.

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Below the Ankle Expertise: Distal Pedal Access with Dr. Marta Lobato on the BackTable VI Podcast)
Ep 448 Below the Ankle Expertise: Distal Pedal Access with Dr. Marta Lobato
00:00 / 01:04

BackTable, LLC (Producer). (2024, May 24). Ep. 448 – Below the Ankle Expertise: Distal Pedal Access [Audio podcast]. Retrieved from

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Podcast Contributors

Dr. Marta Lobato discusses Below the Ankle Expertise: Distal Pedal Access on the BackTable 448 Podcast

Dr. Marta Lobato

Dr. Marta Lobato is a vascular and endovascular surgeon with Hospital Cruces in Barakaldo, Spain.

Dr. Sabeen Dhand discusses Below the Ankle Expertise: Distal Pedal Access on the BackTable 448 Podcast

Dr. Sabeen Dhand

Dr. Sabeen Dhand is a practicing interventional radiologist with PIH Health in Los Angeles.


The discussion covers the importance of visualizing the fifth metatarsal for effective lateral views in X-rays, the intricacies of accessing the lateral and medial plantar arteries, and the significance of starting with easier procedures before attempting more complex interventions. Additionally, Dr. Lobato highlights the role of social media in learning about innovative medical practices.


00:00 - Introduction
05:54 - Below the Knee and Ankle Interventions
15:35 - Complexities of Zone 2 and 3 Access
23:12 - Buddy Needle Technique for Calcified Arteries
30:12 - Advanced Techniques for Supporting the Wire
34:13 - Vasodilator Use
37:12 - Balloon-Assisted Techniques
41:02 - Advancing Your Endovascular Skills


Tips and Tricks for Simple and Complex Below-the-Ankle Punctures:

Buddy Needle Technique to Facilitate Retrograde Puncture of Heavily Calcified Tibial Vessels:

Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach:

Retrograde Balloon-Assisted Approach to Prevent Distal Embolization During Complex Recanalization Procedures:

The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia:

New antioxidant therapy for hard-to-heal neuroischaemic diabetic foot ulcers with deep exposure:

Percutaneous endovascular arteriovenous fistula creation for hemodialysis access using "off-the-shelf" conventional devices:

Disclaimer: The Materials available on 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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Arterial Revascularization Procedure Prep
Critical Limb Ischemia (CLI) Condition Overview
Peripheral Artery Disease Condition Overview

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