Abstract：
UNASSIGNED: To describe a novel bailout technique to approach below-the-ankle (BTA) chronic total occlusions or plantar-arch severe disease where the balloon/catheter is unable to follow the crossing guidewire and no other described recanalization approach is feasible.
UNASSIGNED: When facing a complex BTA revascularization, if the guidewire crosses but the balloon cannot progress due to a lack of pushability, an antegrade puncture of the infrapopliteal vessel where the tip of the guidewire lays is performed. The guidewire is then carefully navigated through this distal BTA vessel into the needle to achieve its rendezvous and externalization. A low-profile balloon is inserted through the femoral access and advanced till the non-crossable point of the BTA vessels. A torque device is then attached to the proximal hub of the balloon, and the through-and-through guidewire is subsequently pulled from the new distal access, allowing the balloon to be dragged across the lesion together with the wire.
UNASSIGNED: The below-the-ankle antegrade teleferic (BAT) technique may be considered for highly complex BTA revascularization procedures where the wire crosses the lesion, but no other device can be tracked over it.
CONCLUSIONS: The clinical impact of this article lies in the description of a bailout technique for BTA revascularization where the guidewire crosses, but no device can be advanced. This technique can be helpful in scenarios where failure to achieve success could result in limb loss. The BAT technique provides a solution in extremely challenging cases, enhancing technical success, improving outcomes and potentially preserving the limbs of patients who would otherwise face amputation, if not revascularized.The video shows the BAT technique performed with a support catheter under fluoroscopy: antegrate puncture of the DP, advancement of the support catheter over the wire, rendezvous of the guidewire in the catheter and subsequent externalization of the wire.
UNASSIGNED: When facing a complex BTA revascularization, if the guidewire crosses but the balloon cannot progress due to a lack of pushability, an antegrade puncture of the infrapopliteal vessel where the tip of the guidewire lays is performed. The guidewire is then carefully navigated through this distal BTA vessel into the needle to achieve its rendezvous and externalization. A low-profile balloon is inserted through the femoral access and advanced till the non-crossable point of the BTA vessels. A torque device is then attached to the proximal hub of the balloon, and the through-and-through guidewire is subsequently pulled from the new distal access, allowing the balloon to be dragged across the lesion together with the wire.
UNASSIGNED: The below-the-ankle antegrade teleferic (BAT) technique may be considered for highly complex BTA revascularization procedures where the wire crosses the lesion, but no other device can be tracked over it.
CONCLUSIONS: The clinical impact of this article lies in the description of a bailout technique for BTA revascularization where the guidewire crosses, but no device can be advanced. This technique can be helpful in scenarios where failure to achieve success could result in limb loss. The BAT technique provides a solution in extremely challenging cases, enhancing technical success, improving outcomes and potentially preserving the limbs of patients who would otherwise face amputation, if not revascularized.The video shows the BAT technique performed with a support catheter under fluoroscopy: antegrate puncture of the DP, advancement of the support catheter over the wire, rendezvous of the guidewire in the catheter and subsequent externalization of the wire.
摘要：
■描述一种新颖的救助技术，以接近踝下（BTA）慢性完全闭塞或足弓严重疾病，其中球囊/导管无法跟随交叉导丝，并且没有其他描述的再通方法是可行的。
■当面对复杂的BTA血运重建时，如果导丝穿过，但由于缺乏可推动性，球囊无法前进，对导丝尖端所在的膝下血管进行顺行穿刺。然后将导丝小心地导航通过该远端BTA血管进入针中以实现其会合和外化。低轮廓的球囊通过股骨通路插入并前进直到BTA血管的不可交叉点。然后将扭矩装置连接到球囊的近端毂，然后将穿通导丝从新的远端通道中拉出，允许气球与电线一起拖过病变。
■对于高度复杂的BTA血运重建手术，可以考虑使用踝关节下顺行远距（BAT）技术，其中导线穿过病变，但没有其他设备可以跟踪它。
结论：本文的临床影响在于描述了导丝交叉的BTA血运重建的救助技术，但没有设备可以先进。这种技术在未能取得成功可能导致肢体丧失的情况下可能是有帮助的。BAT技术在极具挑战性的情况下提供了解决方案，增强技术成功，改善预后并可能保留否则将面临截肢的患者的四肢，如果不是血运重建的话.该视频显示了在透视下使用支持导管进行的BAT技术：对DP进行的前置式穿刺，支撑导管在导线上的推进，导管中导丝的会合和随后的线的外部化。
■当面对复杂的BTA血运重建时，如果导丝穿过，但由于缺乏可推动性，球囊无法前进，对导丝尖端所在的膝下血管进行顺行穿刺。然后将导丝小心地导航通过该远端BTA血管进入针中以实现其会合和外化。低轮廓的球囊通过股骨通路插入并前进直到BTA血管的不可交叉点。然后将扭矩装置连接到球囊的近端毂，然后将穿通导丝从新的远端通道中拉出，允许气球与电线一起拖过病变。
■对于高度复杂的BTA血运重建手术，可以考虑使用踝关节下顺行远距（BAT）技术，其中导线穿过病变，但没有其他设备可以跟踪它。
结论：本文的临床影响在于描述了导丝交叉的BTA血运重建的救助技术，但没有设备可以先进。这种技术在未能取得成功可能导致肢体丧失的情况下可能是有帮助的。BAT技术在极具挑战性的情况下提供了解决方案，增强技术成功，改善预后并可能保留否则将面临截肢的患者的四肢，如果不是血运重建的话.该视频显示了在透视下使用支持导管进行的BAT技术：对DP进行的前置式穿刺，支撑导管在导线上的推进，导管中导丝的会合和随后的线的外部化。
