Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.200126
Jornal Vascular Brasileiro
Therapeutic Challenge

Endovascular revascularization of chronic total arterial occlusion of the lower limb using the SAFARI technique

Revascularização endovascular utilizando a técnica SAFARI em casos de oclusão arterial total do membro inferior

Miguel Alonso-Rojas Huillca; Milagros Moreno-Loaiza; Félix Tipacti-Rodríguez; Manolo Briceño-Alvarado; Wildor Samir Cubas Llalle

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Abstract

Abstract: The SAFARI technique or Subintimal Arterial Flossing with Antegrade-Retrograde Intervention is an endovascular procedure that allows recanalization of Chronic Total Occlusive (CTO) lesions when conventional subintimal angioplasty is unsuccessful. Retrograde access is usually obtained through the popliteal, anterior tibial, dorsalis pedis artery, or posterior tibial arteries and may potentially provide more options for endovascular interventions in limb salvage. The case of an 81-year-old man with a history of uncontrolled hypertension, diabetes mellitus, and dyslipidemia is presented. He presented with a cutaneous ulcer on the right lower limb with torpid evolution and poor healing. The Doppler ultrasound and arteriographic study revealed a CTO lesion of the popliteal artery that was not a candidate for antegrade endovascular revascularization, but was successfully treated using the SAFARI technique. The patient had no perioperative complications, the wound showed better healing, and he was discharged with an indication of daily dressings and control by an external outpatient clinic.

Keywords

critical limb ischemia, subintimal angioplasty, retrograde access, popliteal artery, anterior tibial artery

Resumo

Resumo: A técnica SAFARI, ou Subintimal Arterial Flossing with Antegrade-Retrograde Intervention, é um procedimento endovascular que permite a recanalização de lesões por oclusão total crônica (OTC) em caso de fracasso da angioplastia subintimal convencional. O acesso retrógrado é geralmente obtido através da artéria poplítea, tibial anterior, pediosa ou tibial posterior e pode fornecer mais alternativas de intervenções endovasculares para o salvamento do membro. É apresentado o caso de um homem de 81 anos com histórico de hipertenção não controlada, diabetes melito e dislipidemia. Ele apresentava uma lesão ulcerativa cutânea no membro inferior direito com evolução tórpida e má cicatrização. O ultrassom Doppler e o estudo arteriográfico revelaram uma lesão por OTC na artéria poplítea. O paciente não era candidato a revascularização endovascular anterógrada; sendo assim, esta foi realizada com successo utilizando a técnica SAFARI. O paciente não apresentou complicações perioperatórias e recebeu alta com indicação de cuidados diários com a ferida e controle em um ambulatório externo. Além disso, a ferida apresentou melhor cicatrização.
 

Palavras-chave

isquemia crítica de membros, angioplastia subintimal, acesso retrógrado, artéria poplítea, artéria tibial anterior

References

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Submitted date:
07/12/2020

Accepted date:
11/06/2020

60466020a953957254470732 jvb Articles
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