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CC BY 4.0 · Journal of Clinical Interventional Radiology ISVIR
DOI: 10.1055/s-0045-1812506
Case Report

Crossing the Long Occlusion: Combined Antegrade-Retrograde Rendezvous via Mid-SFA Puncture with an Overview of Hybrid Recanalization Techniques

Authors

  • Mithilesh Arumulla

    1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Mangalagiri, Guntur, Andhra Pradesh, India

  • Yugandhar Samireddypalle 

    1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Mangalagiri, Guntur, Andhra Pradesh, India

  • Prudhvinath Reddy A.

    1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Mangalagiri, Guntur, Andhra Pradesh, India

  • Sridhar V. Prabhu

    1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Mangalagiri, Guntur, Andhra Pradesh, India

  • Amitha Vikrama K. S.

    2   Department of Radiodiagnosis, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Abstract

Long-segment infrainguinal occlusions challenge endovascular interventions. When standard antegrade and retrograde techniques fail, hybrid approaches become vital. We report a case of critical limb ischemia secondary to long-segment superficial femoral artery (SFA) and P1 popliteal occlusion. After failed antegrade recanalization and unsafe retrograde access, a mid-SFA puncture enabled retrograde guidewire entry and successful reentry. Antegrade snaring and balloon angioplasty followed. Mastery of hybrid methods—SAFARI (subintimal arterial flossing with antegrade-retrograde intervention), CART, reverse CART (controlled antegrade and retrograde tracking), PIERCE (percutaneous direct needle puncture of calcified plaque), and wire rendezvous—is crucial for success in complex peripheral interventions.

Keywords

wire rendezvous - retrograde access - hybrid techniques


Publication History

Article published online:
19 November 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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