REVIEW  RECENT DEVELOPMENTS IN THE MANAGEMENT OF THE DIABETIC FOOT 

The Journal of Cardiovascular Surgery 2018 October;59(5):685-91

DOI: 10.23736/S0021-9509.18.10627-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Tips for pedal access: technical evolution and review

Ansar Z. VANCE ¹ ✉, Daniel A. LEUNG ², Timothy W. CLARK ¹

¹ Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; ² Department of Vascular and Interventional Radiology, Christiana Care Health System, Newark, DE, USA

Pedal access has become an indispensable technique for endovascular therapy of complex lower extremity peripheral vascular disease. From an option as a single access in a patient lacking traditional access approaches to a critical maneuver in combined antegrade-retrograde approaches during the treatment of complex chronic total occlusions, pedal access is an essential tool for any endovascular physician treating peripheral arterial disease. Anticipatory planning is critical in the successful utilization of pedal access. The appropriate tibiopedal vessel should be chosen and combined with the ideal access technique. Knowledge of the current medical devices available for pedal access and post-procedural hemostasis is key and can ease the learning curve. We present the evolution of pedal access with a review of the literature and technical tips to incorporate into everyday practice.

KEY WORDS: Diabetic foot - Peripheral arterial disease - Ischemia - Endovascular procedures