Novel Use of the “Contra Catheter” (CC) In Proximal Iliac Artery Chronic Total Occlusion (PICTO) Recanalization

Proximal Iliac Artery chronic total occlusions (PICTOs) are complex peripheral interventions that typically require an arm approach for adequate leverage. These are typically TransAtlantic Inter-Society Consensus [1] (TASC) Type C/ D lesions that have traditionally treated by Aorto-bifemoral surgery [2] but are being increasingly approached by endovascular methods [3,4]. The endovascular approach [4] may be the only option in some patients who are poor surgical candidates due to age, lung disease and comorbidities that typically seen in patients with severe PAD. In addition, endovascular approaches have inherent advantages in that they are less invasive with a shorter length of stay and early recovery and can be performed with local anesthesia [1] and can provide durable results [5].