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Recanalize Infrapopliteal CTOs

This module allows clinicians to practice diagnosis and endovascular treatment of critical limb ischemia, focusing on recanalization of below the knee (infrapopliteal) chronic total occlusions (CTOs). This module also provides practice for performing an antegrade or pedal approach, crossing the occlusion using wire escalation and a retrograde wire snaring technique. After managing to cross the occlusion with a wire, the trainee will be able to perform balloon angioplasty. Included are virtual patient cases presenting posterior and anterior tibial artery occlusions.

Learning Objectives:

  • To practice antegrade and pedal access techniques
  • To practice performing and interpreting diagnostic angiogram of the lower limbs
  • To experience a variety of wires with different properties, including tip load and experience different combinations of wire-catheter to achieve the best support
  • To practice safe positioning of a sheath in the popliteal artery
  • To practice wire escalation technique
  • To practice the subintimal crossing technique
  • To practice safely crossing the occlusion using heavyweight wire, avoiding perforation
  • To practice the snaring of retrograde wire technique
  • To practice proper sizing, safe positioning and inflation of an angioplasty balloon within a chronic total occlusion


Vascular Surgery, Interventional Cardiology, Interventional Radiology


BTK Collage Case Overview
2-Roadmap-of-occlusion Roadmap of Occlusion
3-Subintimal-wire-crossing Roadmap of Occlusion
4-Pedal-wire Pedal Access
5-Snaring-the-retrograde-wire Snaring the Retrograde Wire
3-Wire and sheath cross over to right femoral artery Crossover

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