Cuma SÜLEYMANOĞLU, Rıdvan YURT
Interventional Cardiology Perspectives - 2026;2(1):26-27
Chronic limb-threatening ischemia represents the end stage of peripheral arterial disease. In patients presenting with chronic total occlusions (CTOs) of below-the-knee (BTK) arteries, revascularization can be technically challenging. We report a case of a diabetic patient admitted to our diabetic foot care clinic with a non-healing ulcer and focal gangrene on the dorsal surface of the right foot. Revascularization was successfully achieved using a combination of antegrade hydrodynamic contrast recanalization (HDR) and a retrograde "just marker" technique. This case highlights that reliance on a single approach may be insufficient in complex BTK CTOs. The transition between techniques can be crucial for procedural success. In our case, we believe that the HDR technique at the proximal cap facilitated partial channel formation, allowing the retrograde wire to subsequently cross the lesion. Therefore, an initial technique's apparent failure may, in fact, contribute to overall success when used in combination. We propose that HDR is a valuable option in heavily calcified, long-segment CTOs. A collaborative, hybrid approach that incorporates multiple CTO techniques should be considered essential, as the limitations of one method may directly contribute to the success of another.
