Ep. 448 Below the Ankle Expertise: Distal Pedal Access with Dr. Marta Lobato

BackTable Vascular & Interventional

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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SYNPOSIS

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.

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TIMESTAMPS

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

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RESOURCES

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

https://pubmed.ncbi.nlm.nih.gov/38441118/

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

https://pubmed.ncbi.nlm.nih.gov/28587566/

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

https://pubmed.ncbi.nlm.nih.gov/34989276/

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

https://pubmed.ncbi.nlm.nih.gov/36415934/

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

https://pubmed.ncbi.nlm.nih.gov/38523459/

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

https://pubmed.ncbi.nlm.nih.gov/37029973/

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

https://pubmed.ncbi.nlm.nih.gov/33251393/