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Winther, B. ; Schmidt, A.* ; Sopromadze, L.* ; Düsing, S.* ; Fischer, A.* ; Scheinert, D.* ; Steiner, S. ; Wittig, T.

Pain relief during recanalization of chronic femoropopliteal artery occlusions with use of a crossing catheter.

JACC: Case Reports 30:104638 (2025)

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Background: Demographic shifts have increased the complexity of endovascular therapy, often resulting in painful procedures. Local anesthesia (LA) has become a viable alternative to general anesthesia for high-risk patients undergoing endovascular therapy. Case Summary: A 76-year-old woman presented with severe claudication due to a heavily calcified chronic total occlusion of the superficial femoral artery. After initial subintimal guidewire passage, re-entry into the distal true lumen was achieved using a BeBack crossing catheter. During consecutive balloon inflation, the patient experienced severe discomfort. To improve patient compliance and facilitate balloon dilation of adequate diameter, local infiltration of lidocaine and iodinated contrast medium was administered via the BeBack crossing catheter in the perivascular space along the superficial femoral artery. The procedure was then successfully completed. Discussion: The injection of LA via the BeBack crossing catheter provided targeted pain management, ensuring patient compliance without extending procedure duration or requiring additional percutaneous LA administration. Take-Home Messages: LA is a feasible alternative to general anesthesia for high-risk patients undergoing lower limb revascularization of complex lesions and total occlusions. In clinical cases where a BeBack crossing catheter is already in use, using the catheter for perivascular anesthesia injection offers effective pain management peri-interventionally.

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