Fig. 2

Overview and results of the ViaHole technique. A Initial angiogram showing thrombotic occlusion due to acute limb ischemia; B advancement of retrograde guidewire and microcatheter into the peroneal artery occlusion from distal posterior tibial artery via the posterior perforating branch of the peroneal artery; C successful puncture of the stent-graft with a 20-gauge needle, touching the tip of the retrograde microcatheter; D externalization of the retrograde guidewire through needle hole; E forceful advancement of the retrograde microcatheter over the externalized guidewire across the posterior wall of the stent-graft into the tibioperoneal trunk; F insertion of the antegrade guidewire into the retrograde microcatheter and advancement of the antegrade microcatheter into the peroneal artery; G dilation of the lesion, including the expanded polytetrafluoroethylene hole, using a 3.0 mm noncompliant balloon; H angiogram revealing successful creation of the stent-graft hole and sufficient flow from the peroneal artery (red arrows) to the below-the-ankle arteries; and I 1-year computed tomography angiogram demonstrating patency from the superficial femoral artery to the peroneal artery (white arrows)