Recanalization of concomitant iliac artery and common femoral artery occlusions using an antegrade hybrid (open/endovascular) approach

The endovascular treatment of patients with bulky iliofemoral occlusions usually requires a femoral endarterectomy, coupled with iliac recanalization. This requires crossing the occlusions with a guidewire, which is usually attempted in a retrograde fashion. If this fails, then a surgical inflow procedure is necessary. Antegrade crossing of an iliac occlusion either from the contralateral femoral or transbrachial approach and retrieval of the guidewire during the ensuing femoral endarterectomy obviates the need for luminal reentry, ensures inflow by endovascular recanalization of the iliac artery, and avoids the need for surgical bypass. This underused technique should be considered in such situations, and its details are described.