1425_Ducasse.pdf

1、11-13 December 2025Carrousel du Louvre,Paris#PVI25Access techniques in complexCLTI casesE Ducasse,X Brard,C CaraduUnit of vascular&endovascular surgeryStatement of financial interest2I currently have,or have had over the last two years,an affiliation or financial interests or interests of any order

2、with a company or I receive compensation or fees or research grants with a commercial company:Speakers name:Pr Eric DucasseI currently have no conflict of interest for this presentationMyMy setupsetup Prefer ipsilateral femoral puncture 6F Sheath to treat fem-pop inflow if necessary Or Direct 4Fr Sh

3、eathThen long 4F sheath(x 45/55cm)in the popliteal artery(P3 segment)pushability/support quality of contrast injection quantity of contrast mediaOption to switch for long 7Fr sheathfor kissing balloon of ATA/TPTMy guidewires of ChoiceShapablePreshapedV18Use a small needle or fingers to shape the tip

4、Shaping of guidewire tip is kept as short as possible in length1.0mm-2.0mm from the tip of guidewirewith angle 4050 curve initially to penetrate proximal fibrous capGentle secondary curve1520 curve at 3mm4mm proximal to distal tip to navigate into CTO body to orient tip and to cross long distal fibr

5、ous capWorkhorse:0.018Guidewires dedicated to different techniquesGuidewire with polymer+hydrophilic coatingSliding TechniqueDrilling TechniqueStiff hydrophobicguidewire/non tapperedPenetration TechniqueAlternative to the drillingtechniqueSeverly calcifiedlesions/resisting CTOsSuper-stiff guidewire/

6、tapperedMicrochannel Techniquemajority of CTOs have intraluminalmicrochannels from 100m500mproximal fibrous cap is first centrally penetratedto 1mm2mm with very stiff guidewire and support cathetercareful injection of undiluted contrast(1mL)immediately distal to proximal cap of CTO identifies and en