Feasibility and safety of proximal anterior tibial artery direct puncture with a needle technique for the ostium occlusion with severe calcification

Background Although endovascular therapy is often used for revascularization in patients with chronic limb-threatening ischemia, highly calcified lesions below the knee still remain challenging and difficult to treat. To treat such lesions, a hard-tip guidewire or a bidirectional approach can be used to aid the passage of the guidewire and thereby perform balloon dilatation. In contrast, when a severe calcified lesion is present at a highly flexural area, such as the origin of the anterior tibial artery (ATA), passing the guidewire is extremely difficult because the route of the guidewire is restricted.