Diagnostic and Interventional Radiology
Interventional Radiology - Technical Note

Looking beyond the gunsight: A potential bailout technique for arterial and venous recanalization


Department of Radiology, Division of Vascular and Interventional Radiology, UCLA Medical Center, Los Angeles, California, USA

Diagn Interv Radiol 2022; 28: 260-263
DOI: 10.5152/dir.2022.21095
Read: 186 Downloads: 58 Published: 01 March 2021

The “gunsight approach” was initially described as the use of overlapping snares and through- and-through puncture of the portal vein and inferior vena cava for the creation of a transcaval portosystemic shunt. This technique can be adapted for the creation of an extra-anatomic chan- nel between any 2 locations where snares can be deployed. We explain the technique, discuss finer technical points, and describe 2 cases where refractory vascular occlusions are crossed using this technique. The first case involves an extensively calcified femoral arterial chronic total occlusion where subintimal tracking past the occlusion is achieved, but luminal re-entry is ham- pered by dense calcific plaque refractory to multiple re-entry devices. The second case involves a chronic venous occlusion along the femoral vein with loss of in-line flow due to prior stenting. In both cases, the gunsight technique was successfully used as a bailout option after standard recanalization techniques were unsuccessful.

You may cite this article as: Kao SD, Srinivasa RN, Callese T, Jamshidi N, Plotnik A. Looking beyond the gunsight: A potential bailout technique for arterial and venous recanalization. Diagn Interv Radiol. 2022;28(3):260-263.

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