The guidewire is removed. Using subtraction angiography, an arteriogram is performed of the popliteal and proximal tibial vessels. If there is no evidence of acute tibial occlusion (i.e. abrupt occlusion of undiseased vessel), then the rest of the thrombectomy procedure will be directed only at the popliteal and SFA.
If there is tibial involvement, smaller guidewires and balloons may be selected to facilitate the selective cannulation of these vessels (e.g. 3F, .018” guidewire compatible). A balloon may be inflated just proximal to an occlusion and local thrombolytic therapy administered to avoid balloon trauma to the vessel wall.
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