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It is estimated that six thousand diagnostic cardiac catheterizations and two thousand coronary angioplasties are performed per million inhabitants per year1, all by retrograde approach. Roughly, for every six thousand procedures, one patient has diffuse injury of the arterial system, with involvement of the four extremities2. Despite the difficulty of arterial access, the anatomical diagnosis of coronary artery disease today is no longer a barrier. It is currently possible to conduct anatomical studies without the need for invasive study, especially due to the improved image quality of coronary CT angiography. However, coronary intervention is still a barrier, as larger profile catheters are used and anticoagulation is needed.

Transseptal Coronary Angioplasty in Patients with Severe Peripheral Vascular Disease