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Matthaiou N, Klontzas ME, Kakkos GA, Tsetis K, Maris TG, Ioannou CV, Tsetis D, Kehagias E. Utility of Dual-Energy Computed Tomography in lesion characterization and treatment planning for peripheral Chronic Total Occlusions: A comprehensive analysis of crossing difficulty. Eur J Radiol 2024; 176:111539. [PMID: 38833769 DOI: 10.1016/j.ejrad.2024.111539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/18/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To investigate whether Dual-Energy Computed Tomography (DECT) could be useful in the lesion characterization and endovascular treatment planning of symptomatic patients with peripheral arterial disease (PAD) due to Chronic Total Occlusions (CTO). MATERIALS AND METHODS Between 2018 and 2022, 60 symptomatic patients (52 male, age 71 years) with peripheral arterial CTO underwent DECT angiography before percutaneous endovascular treatment. Patients were classified, according to guidewire crossing difficulty into four categories, which were subsequently correlated with DECT values, including Dual Energy Index (DEI) and Effective Z (Zeff). DECT values were also corelated with crossing time. The crossing difficulty was further correlated with the Trans-Atlantic Inter-Society Consensus Document (TASC II) classification. RESULTS Technical success, defined as perceived antegrade true lumen or subintimal crossing, was achieved in 76.7 %. Among the cases, 20 were deemed easy, 14 moderate, 12 hard and 14 were failed attempts. Statistical analysis revealed a significant correlation between DEI, Zeff values, and the crossing difficulty categories (p < 0.001). Additionally, there was also a correlation between crossing time and DECT values. However, no significant correlation was recorded between difficulty categories and TASC II classification. CONCLUSION Pre-procedural DECT angiography provides valuable information for patient selection and planning of the revascularization strategy. Moreover, it is helpful in the selection of the appropriate PTA materials, based on the lesion characteristics. Further research should be invested in this important field, to determine the optimal treatment approach in patients suffering from PAD due to CTOs.
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Affiliation(s)
- Nikolas Matthaiou
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece.
| | - Michail E Klontzas
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece.
| | - George A Kakkos
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
| | - Konstantinos Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Thomas G Maris
- Department of Medical Physics, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
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Beasley RE, Martin J. A commentary on “Factors contributing to efficient recanalization procedures for chronic total occlusion of the superficial femoral artery”. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 37:50-51. [DOI: 10.1016/j.carrev.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/03/2022]
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Tadano Y, Kotani JI, Haraguchi T, Watanabe T, Sugie T, Kaneko U, Kobayashi K, Kanno D, Kashima Y, Fujita T. Factors contributing to efficient recanalization procedures for chronic total occlusion of the superficial femoral artery. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:43-49. [PMID: 34266771 DOI: 10.1016/j.carrev.2021.06.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/29/2021] [Accepted: 06/28/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study aimed to clarify the factors for efficient procedures (EP) in superficial femoral artery (SFA) chronic total occlusion (CTO). METHODS We retrospectively analyzed 200 consecutive limbs that underwent treatment for SFA CTO. The patients were divided into three groups according to the main strategies: subintimal angioplasty (SIA) (n = 123), Crosser use (n = 50), and 0.014″ CTO guidewire (CTO-GW) (n = 27). To determine the factors for an EP (EP; contrast volume <130 mL and procedure time <20 min; derived from non-CTO [control] procedures), the variables (P < 0.2) underwent multivariate analysis. RESULTS SIA included more Trans-Atlantic Inter-Society Consensus C/D lesions and contralateral femoral approaches, and additional GW use (P < 0.05). CTO-GW presented a shorter occlusion length and elapsed time, and used less retrograde approach than the other strategies (P < 0.05). Crossers had a higher incidence of perforation (P = 0.002). The prompt retrograde approach had a similar actual retrograde procedure time, but a shorter total procedure time, compared to that of the delayed adoption (P < 0.001). EP was achieved in 14 limbs (7.0%). Multivariate analysis revealed that occlusion length (adjusted odds ratio [OR], 0.89; 95% CI, 0.81-0.96; P = 0.004) and SIA (OR, 8.71; 95% CI, 1.32-175.27; P = 0.02) were associated with EP. CONCLUSIONS SIA contributed to EP. The timing of the retrograde approach was crucial because its delay resulted in an excessive procedure time.
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Affiliation(s)
- Yutaka Tadano
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
| | - Jun-Ichi Kotani
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Takuya Haraguchi
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | | | - Takuro Sugie
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
| | - Umihiko Kaneko
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
| | - Ken Kobayashi
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
| | - Daitaro Kanno
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
| | | | - Tsutomu Fujita
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan
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ACCROCCA F, SIANI A, GABRIELLI R, DE VIVO G, SMEDILE G, RIZZO AR, CASTRUCCI T, BARTOLI S. The insidious femoropopliteal tract. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.23736/s1824-4777.21.01493-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Krankenberg H. In Front of Locked Doors-Femoropopliteal Chronic Occlusions: Is Drug-Coated Balloon Angioplasty With Provisional Stenting the Matching Key? JACC Cardiovasc Interv 2019; 12:494-496. [PMID: 30846090 DOI: 10.1016/j.jcin.2018.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 12/26/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Hans Krankenberg
- Vascular Medicine Center, Department of Angiology, Asklepios Klinikum Harburg, Hamburg, Germany.
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Kim K, Ko YG, Ahn CM, Min PK, Lee JH, Yoon CH, Yu CW, Lee SW, Lee SR, Choi SH, Koh YS, Chae IH, Choi D. Clinical Outcomes of Subintimal vs. Intraluminal Revascularization Approaches for Long Femoropopliteal Occlusions in a Korean Multicenter Retrospective Registry Cohort. Circ J 2018; 82:1900-1907. [PMID: 29681585 DOI: 10.1253/circj.cj-17-1464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are limited data comparing the outcomes of subintimal vs. intraluminal approach in the treatment of long femoropopliteal artery occlusions. The objective of this study was to investigate the efficacy and safety of the subintimal approach for long femoropopliteal artery occlusions.Methods and Results:From a multicenter retrospective registry cohort, we included a total of 461 patients with 487 femoropopliteal artery occlusions classified as Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) II C/D for this analysis. We compared the immediate and mid-term outcomes of subintimal vs. intraluminal approaches. There were 228 patients with 243 limbs in the subintimal group, and 233 patients with 244 limbs in the intraluminal group. Baseline clinical and lesion characteristics were comparable between the 2 groups. The technical success rate was significantly higher in the subintimal group than in the intraluminal group (95.1% vs. 89.8%, P=0.041). The clinical primary patency (67.5% vs. 73.4% at 12 months, 54.0% vs. 61.3% at 24 months; P=0.086) and target lesion revascularization (TLR)-free survival (89.5% vs. 86.3% at 12 months, 77.6% vs. 76.0% at 24 months; P=0.710) did not differ significantly between the subintimal and the intraluminal groups. CONCLUSIONS In long femoropopliteal occlusions, the subintimal approach achieved a higher technical success rate and similar mid-term primary patency and TLR-free survival compared with intraluminal approach.
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Affiliation(s)
- Kyu Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Pil-Ki Min
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Jae-Hwan Lee
- Division of Cardiology, Chungnam National University Hospital
| | - Chang-Hwan Yoon
- Division of Cardiology, Seoul National University Bundang Hospital
| | | | - Seung Whan Lee
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan
| | - Sang-Rok Lee
- Division of Cardiology, Chonbuk National University Hospital
| | - Seung Hyuk Choi
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yoon Seok Koh
- Division of Cardiology, Seoul St. Mary's Hospital, the Catholic University of Korea
| | - In-Ho Chae
- Division of Cardiology, Seoul National University Bundang Hospital
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
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