# RIVER Technique: Retrograde IVUS Endovascular Revascularization of Anomalous Tibial Chronic Total Occlusions

## TL;DR

A new technique called RIVER helps treat difficult foot ulcers by revascularizing arteries when standard methods fail.

## Contribution

The RIVER technique provides a novel endovascular approach for revascularizing anomalous tibial chronic total occlusions.

## Key findings

- Retrograde access at the posterior tibial artery successfully revascularized an anomalous occlusion.
- Intravascular ultrasound confirmed proper wire placement and led to ulcer healing.
- The RIVER technique is effective when antegrade revascularization attempts fail.

## Abstract

A 62-year-old man presented with a long-standing history of a nonhealing ulcer to the left foot. Previous antegrade revascularization attempts failed. Retrograde access was obtained at the posterior tibial artery, but the wire traveled away from the tibial peroneal trunk and connected at the popliteal artery. Intravascular ultrasound confirmed intraluminal passage of the wire, which led to successful revascularization of the posterior tibial artery and ulcer healing.

The RIVER (Retrograde Intravascular ultrasound Endovascular Revascularization of Anomalous Tibial Chronic Total Occlusions) technique is a useful strategy for revascularization of anomalous tibial occlusions when standard antegrade approaches fail.