Leipzig live case Thu 08.30 LINC 9.6.22 - Antegrade Retrograde combo technique

Andrej emphasises the long pop occlusion, the plentiful collaterals and - he points out - the shadow of the native vessel just about visible

It is mainly the PTA that fills - but the origin is not seen. Andrej points out the PeA on this filling. He chose the PeA for his retro distal access on the basis seemingly that the PTA origin was not clear… ? I have a feeling it was more that he wished to demo the PeA puncture technique!

Fluoro roadmap guided puncture of the PeA. The seen vessel here is the PTA. Andrej emphasises that needle path should be parallel to the target vessel. He states that the approach to the vessel is “anterior”. The C-arm looks to be in an ipsi oblique - this is the left leg and the angle is LAO 29 on the image just before the magnified view with the needle; that is the impression I had at the time too. He then reverts to a contralat oblique RAO view to corroborate needle position and entry and then continues to work in that view.

He does the next DSA to confirm for certain that he is indeed in the PeA and not the PeV; the PeA is seen outlined lightly but certainly overlying the wire coming up from below.

The wire going up the PeA from below first turns laterally out into a collateral; then it turns medially and Andrej susses that it may in fact have gone into the PTA origin.