Technique to Facilitate Retrograde Puncture of Mid to Upper Calf Tibial Vessels

J Endovasc Ther . 2018 Oct;25(5):611-613. doi: 10.1177/1526602818793996. Epub 2018 Aug 13.

Fecha de la publicación: 13/08/2018

Autor: August Ysa (1), Marta Lobato (1), Roberto Gómez (1), Amaia Arruabarrena (1), Ana M Quintana (1), Ederi Mikelarena (2), Matthew Metcalfe (3), Juan L Fonseca (1)

Palabras clave: Calcification, Needle, Peroneal artery, posterior tibial artery, Puncture, Retrograde approach, Telescoping needle technique, Tibial artery



1 Vascular Surgery Department, Hospital de Cruces, Barakaldo, Spain.

2 Vascular Surgery Department, Hospital Donostia, Spain.

3 Vascular Surgery Department, Lister Hospital, Stevenage, UK.


Purpose: To describe a simple maneuver to facilitate the retrograde puncture of challenging tibial vessels in the lower leg.

Technique: Because of the depth of the tibial vessels at the mid to upper calf, especially in obese or muscular patients, a 7- or 9-cm, 21-G micropuncture needle is often needed to reach the artery. However, the low profile of the needle contributes to its flexibility and therefore the tendency to bend as it progresses through the deep tissues, hindering access to the target vessel. To overcome this obstacle, a 4- to 5-cm, 18-G needle is initially placed pointing to the artery. The 21-G needle is advanced through it to the target site. This simple maneuver increases the support to the 21-G needle, preventing its bending and facilitating arterial puncture in the presence of calcified vessels.

Conclusion: The telescoping needle technique may be considered as a bailout procedure in the retrograde tibial approach after failed attempts secondary to needle bending or calcified vessels.