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Electric-Field-Based Guidance for Percutaneous Catheter Vessel Crossing. SENSORS 2022; 22:s22134928. [PMID: 35808416 PMCID: PMC9269779 DOI: 10.3390/s22134928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 12/10/2022]
Abstract
Percutaneous procedures to divert blood flow from one blood vessel to another can be performed with intravascular catheters but demand a method to align a crossing needle from one vessel to another. Fluoroscopic imaging alone is not adequate, and it is preferable to have a sensor on one catheter that detects the correct alignment of an incoming needle. This can be implemented by generating dipole electric fields from the crossing catheter which are detected by a receiving catheter in the target vessel and, thus, can calculate and display the degree of alignment, permitting the operator to rotate the crossing catheter to guarantee alignment when deploying a crossing needle. Catheters were built using this concept and evaluated in vitro. The results show that accurate alignment is achieved, and a successful crossing can be made. The concept is being further developed for further clinical evaluation.
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Azzaretti A, Trevisan D, Fachinetti C, Borghi C, Vannelli A. Trans-prosthetic recanalization of a collapsed iliac limb using the GoBack catheter: a case report. CVIR Endovasc 2021; 4:57. [PMID: 34232413 PMCID: PMC8263817 DOI: 10.1186/s42155-021-00244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background Recanalization of graft limb occlusion can prove challenging and the use of the GoBack crossing and reentry device may be a suitable option, especially when there is no other way to restore flow with an usual endovascular approach. The GoBack catheter is a novel device designed to enhance pushability, and to enable direction-change inside hard plaques and crossing of tough lesions, even when they involve graft fabric. Case presentation It’s reported a case of a 76-year-old male who presented with claudication, previous placement of an aorto-bi iliac graft by open surgery for a ruptured abdominal aneurysm 10 years ago that, over time, developed severe kinking on the left limb and a fabric occlusion on the right limb. After several unsuccessful attempts to cross the occlusion of the right common iliac artery, the GoBack™ was deployed to create a lumen through graft’s folds. After angioplasty and stenting a satisfactory result was achieved, restoring flowCT-scan at 1 month and duplex ultrasound (DUS) at 3 months confirmed the patency of ilio-femoral axis. Conclusions The advent of this new CTO crossing device has the potential to facilitate recanalization of some of the most challenging occlusions. Facilitating more consistent distal entry and allowing for a decrease in crossing time. Therefore, the GoBack catheter should be considered as a potential complementary tool to treat vascular occlusions via endovascular approaches, especially when classical endovascular techniques fail.
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Affiliation(s)
- Andrea Azzaretti
- FF UOC Radiodiagnostica, Valduce Hospital, Via Dante Alighieri 11, 22100, Como, Italy.
| | - Daniele Trevisan
- U.O.C. Chirurgia Generale, Valduce Hospital, Via Dante Alighieri, 11, 22100, Como, Italy
| | - Camilla Fachinetti
- FF UOC Radiodiagnostica, Valduce Hospital, Via Dante Alighieri 11, 22100, Como, Italy
| | - Claudia Borghi
- FF UOC Radiodiagnostica, Valduce Hospital, Via Dante Alighieri 11, 22100, Como, Italy
| | - Alberto Vannelli
- U.O.C. Chirurgia Generale, Valduce Hospital, Via Dante Alighieri, 11, 22100, Como, Italy
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Abstract
Effective revascularization of the patient with peripheral artery disease is about more than the procedure. The approach to the patient with symptom-limiting intermittent claudication or limb-threatening ischemia begins with understanding the population at risk and variation in clinical presentation. The urgency of revascularization varies significantly by presentation; from patients with intermittent claudication who should undergo structured exercise rehabilitation before revascularization (if needed) to those with acute limb ischemia, a medical emergency, who require revascularization within hours. Recent years have seen the rapid development of new tools including wires, catheters, drug-eluting technology, specialized balloons, and biomimetic stents. Open surgical bypass remains an important option for those with advanced disease. The strategy and techniques employed vary by clinical presentation, lesion location, and lesion severity. There is limited level 1 evidence to guide practice, but factors that determine technical success and anatomic durability are largely understood and incorporated into decision-making. Following revascularization, medical therapy to reduce adverse limb outcomes and a surveillance plan should be put in place. There are many hurdles to overcome to improve the efficacy of lower extremity revascularization, such as restenosis, calcification, microvascular disease, silent embolization, and tools for perfusion assessment. This review highlights the current state of revascularization in peripheral artery disease with an eye toward technologies at the cusp, which may significantly impact current practice.
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Affiliation(s)
- Joshua A Beckman
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN (J.A.B.)
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California, San Francisco (P.A.S., M.S.C.)
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco (P.A.S., M.S.C.)
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Lui D, Popa S, Dickinson RJ, Patrone L. Distal Re-Entry to Treat Lower Limb Chronic Total Occlusions Using a Novel Electrically Guided Re-Entry Catheter. EJVES Vasc Forum 2021; 51:5-8. [PMID: 34027511 PMCID: PMC8131890 DOI: 10.1016/j.ejvsvf.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/28/2021] [Accepted: 04/14/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction Endovascular treatment of challenging infra-inguinal peripheral vascular disease is increasingly common because of new techniques and improved tools. The use of a novel electrically guided 5 F re-entry catheter is presented. By emitting a minute electrical field, detected by a target wire inserted from an opposing access, the catheter's orientation is accurately displayed to the operator, allowing precise re-entry without the need for fluoroscopic alignment. Report An 84 year old man with tissue loss was treated for a long occlusion of the superficial femoral artery and tibial vessels. Successful subintimal recanalisation was achieved with the help of the ePATH re-entry catheter, restoring inline flow to the foot. Conclusion This re-entry catheter benefits from an intuitive alignment method, smaller profile, and operator adjustable needle travel, making it a versatile tool for endovascular cases. Heavily calcified CTOs are challenging to treat endovascularly. A novel electrically guided re-entry catheter is presented. This 5F device doesn’t need fluoroscopic alignment and needle is adjustable in length. The re-entry system requires bidirectional approach to safely cross into true lumen. The first in human use of this device in a complex popliteal occlusion is described.
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Affiliation(s)
- Dennis Lui
- West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow (London), UK
| | - Sorin Popa
- Department of Bioengineering, Imperial College London, London, UK
| | | | - Lorenzo Patrone
- West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow (London), UK
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Stern JR, Connolly PH, Meltzer AJ. Retrograde Endovascular With Intimal Re-Entry Through Endarterectomy: The REWIRE Technique. Ann Vasc Surg 2021; 76:218-221. [PMID: 34004322 DOI: 10.1016/j.avsg.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Hybrid lower extremity revascularization has been well described, typically consisting of common femoral endarterectomy (CFE) followed by direct patch puncture and endovascular treatment of any distal disease. We describe a modified technique that obviates the need for endovascular re-entry and simplifies treatment at the proximal and distal endpoints. METHODS The REWIRE technique begins with retrograde arterial access via a patent tibial, pedal or femoropopliteal vessel. The diseased segment is crossed in the subintimal plane. Once the wire reaches the common femoral artery (CFA), the vessel is surgically exposed. Arteriotomy is performed and the wire is externalized during standard CFE. With through-wire access achieved, a sheath is inserted and the distal disease is treated. The proximal extent of the endovascular revascularization is incorporated into a standard CFE with patch angioplasty. RESULTS Seven patients with chronic limb-threatening ischemia were treated with this approach, all with long segment occlusions of the SFA and significant CFA disease. The SFA disease was stented and bovine pericardial patch was used for CFE in all. Technical success was achieved in all patients. There were no complications related to the retrograde puncture site, which was controlled with manual pressure (4) or excluded with a covered stent (3). Thirty-Day freedom from major adverse limb events was 100%. CONCLUSIONS The REWIRE technique is an effective approach to hybrid revascularization involving the CFA. By crossing the occluded segment in a retrograde fashion and surgically externalizing the wire during CFE, the proximal and distal endpoints can be addressed with ease, the profunda femoris is protected under direct visualization, and the need for endovascular re-entry is eliminated.
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Affiliation(s)
| | - Peter H Connolly
- New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
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Rippel K, Ruhnke H, Jehs B, Decker J, Kroencke T, Scheurig-Muenkler C. Targeted tibio-peroneal re-entry during subintimal revascularization using the Outback® catheter. CVIR Endovasc 2021; 4:18. [PMID: 33507408 PMCID: PMC7843800 DOI: 10.1186/s42155-021-00206-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Re-entry devices are used regularly in subintimal recanalization of chronic occlusions of the iliac and femoro-popliteal arteries and significantly contribute to the high success rate of these interventions. However, the use in tibio-peroneal arteries has only been described in few cases so far. The present work is a retrospective evaluation of the Outback® re-entry device for gaining targeted true lumen access at the level of the tibio-peroneal arteries. METHODS From 9/2017 until 10/2020 the Outback® catheter was used in case of failed spontaneous re-entry at the level of the tibio-peroneal arteries in 14 patients either instead of the usual retrograde approach via a pedal/distal-crural access (n = 11) or in combination with it (n = 3). Baseline demographic and clinical data, morphologic characteristics of the occlusions, procedural succedss, as well as the Society of Vascular Surgery (SVS) runoff score before and after revascularization were documented. RESULTS All patients (median age: 78 years; range: 66-93) suffered from peripheral artery occlusive disease Rutherford stage 4 to 6 with a median lesion length of 12 cm (range: 7-35). Technical and procedural success was achieved in all 14 patients. The mean re-entry accuracy was 0.25 cm (range: 0-0.8). The SVS runoff score improved from a median of 14.5 (interquartile range IQR: 10.8-16.4) to 7 (IQR: 6.3-7) (p < 0.01). CONCLUSIONS The use of the Outback® catheter for targeted tibio-peroneal re-entry is associated with a high technical and procedural success rate and should be considered in case of otherwise failed ante- and retrograde recanalization.
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Affiliation(s)
- K Rippel
- Department of Diagnostic and Interventional Radiology, University hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
| | - H Ruhnke
- Department of Diagnostic and Interventional Radiology, University hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - B Jehs
- Department of Diagnostic and Interventional Radiology, University hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - J Decker
- Department of Diagnostic and Interventional Radiology, University hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - T Kroencke
- Department of Diagnostic and Interventional Radiology, University hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - C Scheurig-Muenkler
- Department of Diagnostic and Interventional Radiology, University hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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El Khoury R, Cataneo JL, Paredes JA, Schwartz AM, Jacobs CE, White JV, Schwartz LB. "Failure-to-Cross" in Patients Undergoing Percutaneous Peripheral Intervention: The Nonreimbursed Procedure. Ann Vasc Surg 2020; 70:349-354. [PMID: 32603846 DOI: 10.1016/j.avsg.2020.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/04/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Percutaneous peripheral intervention (PPI) is often the first mode of therapy for patients with symptomatic arterial occlusive disease. Technical success generally remains high although "failure-to-cross" still complicates 5-20% of cases. Extended efforts to cross long, occlusive lesions can utilize significant hospital and practitioner resources. The hospital is typically reimbursed for this effort as facility fees are charged by the hour and materials are charged per use. However, given the lack of a CPT® code for "failure-to-cross," practitioners are rarely appropriately compensated. The purpose of this study is to analyze the predictors, technical details, outcomes, and costs of "failure-to-cross" during PPI. METHODS All PPI procedures over a 2-year period at a single institution were retrospectively reviewed. Clinical characteristics, results, costs, and reimbursements obtained from hospital cost accounting were compared among successful therapeutic interventions, crossing failures, and diagnostic angiograms without attempted intervention. RESULTS A total of 146 consecutive PPIs were identified; the rate of "failure-to-cross" was 11.6% (17 patients). The majority of patients with "failure-to-cross" were male (82%) with single-vessel runoff (53%). Compared to successful interventions, the incidences of chronic limb-threatening ischemia (82% vs. 70%, P = 0.34) and infrapopliteal occlusive disease were similar (47% vs. 31%, P = 0.20). "Failure-to-cross" procedures were just as long as successful procedures; there were no significant differences in fluoroscopy time (27 ± 10 vs. 24 ± 14 min, P = 0.52), in-room time (106 ± 98 vs. 103 ± 44 min, P = 0.84), or contrast dye volume utilization (73 ± 37 vs. 96 ± 54 mL, P = 0.12). As expected, "failure-to-cross" procedures incurred far higher hospital charges and costs compared to noninterventional diagnostic angiograms (charges $13,311 ± 6,067 vs. $7,690 ± 1,942, P < 0.01; costs $5,289 ± 2,099 vs. $2,826 ± 1,198, P < 0.01). Despite the additional time and effort spent attempting to cross difficult lesions, the operators were reimbursed at the same low rate as a purely diagnostic procedure (average fee charge $7,360; average reimbursement $992). After 1 year, the 17 patients in whom lesions could not be crossed were treated with advanced interventional procedures with success (n = 2), surgical bypass grafting (n = 5), extremity amputation (n = 4), or no additional intervention in their salvaged limb (n = 6). CONCLUSIONS Patients whose lesions cannot be crossed during PPI fare worse than patients undergoing successful interventions. Hospital costs and charges appropriately reflect the high technical difficulty and resource utilization of extended attempts at endovascular therapy. For practitioners, crossing lesions during PPI is truly a "pay-for-performance" procedure in that only successful procedures are reasonably reimbursed.
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Affiliation(s)
- Rym El Khoury
- Department of Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, Park Ridge, IL
| | - Jose L Cataneo
- Department of Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, Park Ridge, IL
| | - Juan A Paredes
- Department of Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, Park Ridge, IL
| | | | - Chad E Jacobs
- Department of Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, Park Ridge, IL
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, Park Ridge, IL
| | - Lewis B Schwartz
- Department of Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, Park Ridge, IL.
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Tamburrini L, Weisser G, Espinola-Klein C. Reentry devices for chronic arterial occlusions. VASA 2019; 48:451-452. [DOI: 10.1024/0301-1526/a000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Luca Tamburrini
- Center of Cardiology – Cardiology I, Section of Angiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Gerhard Weisser
- Center of Cardiology – Cardiology I, Section of Angiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Christine Espinola-Klein
- Center of Cardiology – Cardiology I, Section of Angiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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Ysa A, Lobato M, Ortiz de Salazar L, Bonmati G, Arroniz A, Metcalfe M, Fonseca JL. Femoropopliteal CTO Subintimal Recanalization Using a Homemade Reentry Device. Ann Vasc Surg 2019; 58:384.e15-384.e18. [PMID: 30763703 DOI: 10.1016/j.avsg.2018.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/29/2018] [Accepted: 11/12/2018] [Indexed: 11/15/2022]
Abstract
A case of a femoropopliteal recanalization procedure using a new bailout technical maneuver to aid reentry into the true lumen is described. After a failed standard reentry attempt, at the level of the vessel reconstitution in the subintimal space, the guidewire was exchanged for a GooseNeck Snare Kit. A needle was inserted across the target artery, piercing both arterial walls and passing through the snare loop. Once the needle had exited the artery, a wire was inserted and the needle withdrawn. The snare was closed, withdrawn, and the wire externalized through the femoral access. Finally, a catheter was advanced from the antegrade sheath up to the arterial reconstitution. Selective injection at the site of reentry confirmed the intraluminal position, and the procedure was successfully completed from the antegrade sheath.
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Affiliation(s)
- August Ysa
- Vascular Surgery Dpt. Hospital de Cruces, Barakaldo, Spain.
| | - Marta Lobato
- Vascular Surgery Dpt. Hospital de Cruces, Barakaldo, Spain
| | | | | | - Amaia Arroniz
- Vascular Surgery Dpt. Hospital de Cruces, Barakaldo, Spain
| | | | - Juan L Fonseca
- Vascular Surgery Dpt. Hospital de Cruces, Barakaldo, Spain
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Kondapalli A, Jeon-Slaughter H, Lu H, Xu H, Khalili H, Prasad A, Armstrong EJ, Brilakis ES, Banerjee S. Comparative assessment of patient outcomes with intraluminal or subintimal crossing of infrainguinal peripheral artery chronic total occlusions. Vasc Med 2017; 23:39-45. [DOI: 10.1177/1358863x17735192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study compares procedural complications and clinical outcomes between subintimal crossing versus intraluminal crossing during endovascular treatment of infrainguinal peripheral artery chronic total occlusions (CTO). We identified 1335 CTO interventions in 1001 patients from the multicenter Excellence in Peripheral Artery Disease (XLPAD) registry from January 2005 to October 2015. Outcomes included 30-day and 12-month all-cause death, non-fatal myocardial infarction or stroke, peripheral artery stent, or vessel, thrombosis (ST), need for any target limb endovascular or surgical revascularization, target limb major amputation and procedural complications. A subintimal crossing technique was necessary in 388 lesions (27% overall in 1335 lesions; 34% ( n=351) in 1023 femoropopliteal lesions, and 12% ( n=37) in 312 infrapopliteal lesions, p<0.01) with a lower procedural ( p<0.01) and technical ( p<0.01) success than the intraluminal in both femoropopliteal and infrapopliteal interventions. There were no significant differences in procedural complications, major adverse cardiac events, or clinically driven target limb revascularization at 1 year between the two groups, except a higher residual dissection rate in the subintimal crossing group than the intraluminal group in femoropopliteal target vessels ( p = 0.04).
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Affiliation(s)
- Ananya Kondapalli
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Haekyung Jeon-Slaughter
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- VA North Texas Healthcare System, Dallas, TX, USA
| | - Hua Lu
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hao Xu
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Houman Khalili
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- VA North Texas Healthcare System, Dallas, TX, USA
| | - Anand Prasad
- Department of Cardiology, University of Texas Health Science Center at San Antonio, TX, USA
| | | | - Emmanouil S Brilakis
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Center for Advanced Coronary Interventions at the Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Subhash Banerjee
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- VA North Texas Healthcare System, Dallas, TX, USA
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Morphological characteristics of chronic total occlusion: predictors of different strategies for long-segment femoral arterial occlusions. Eur Radiol 2017; 28:897-909. [DOI: 10.1007/s00330-017-5003-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/16/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
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12
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Cannavale A, Ali T, Shen CY, Kassimis G, Krokidis M. Recanalization of peripheral chronic total occlusions: 'no fancy devices, just a crossing catheter'. Expert Rev Cardiovasc Ther 2017; 15:221-225. [PMID: 28256175 DOI: 10.1080/14779072.2017.1297229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chronic total occlusions (CTOs) are challenging to treat endovascularly. Classic subintimal approach is offering only moderate success rates mainly due of the lack of dedicated crossing catheters. Purpose of this study is to assess the acute procedural success of the use of a novel hydrophilic crossing catheter in the recanalization of peripheral CTOs. MATERIALS AND METHODS This is a retrospective, single-centre study of patients with femoropopliteal CTOs. Revascularization was performed with the use of the NaviCross®- crossing catheter (Terumo Europe). Technical, procedural success and complications were assessed. RESULTS Thirty-two patients were included in the study. Mean age was 65.9 (46-85) years; Critical limb ischemia was the indication for the procedure in 26 (81%). Target vessels included 12 superficial femoral arteries, 9 popliteal, and 11 femoropopliteal segment lesions. Mean length was 85 (50-350) mm; 21(65.6%) lesions were heavily calcified. In all cases a sub-intimal approach was used; in 21 cases the procedure was performed as a day case. Technical success was achieved in 31 (96.8%) cases. Recanalization was achieved with a guidewire in 22 (71%) lesions and with the catheter alone in 9 (29%) cases. Procedural success was achieved in all lesions. No major adverse events occurred. CONCLUSION The use of the NaviCross®- crossing catheter showed high rate of technical and procedural success in challenging femoropopliteal CTOs without significant complications. The use of this catheter needs to be considered as the first approach for CTOs prior to the use of any other more complex re-entry device.
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Affiliation(s)
- Alessandro Cannavale
- a Department of Radiology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Tariq Ali
- a Department of Radiology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Chen-Yang Shen
- b Department of Peripheral Vascular Surgery , Fuwai Hospital, National Center for Cardiovascular Diseases , Beijing , China
| | - George Kassimis
- c Department of Cardiology , Gloucestershire Hospitals NHS Foundation Trust , Cheltenham , UK
| | - Miltiadis Krokidis
- a Department of Radiology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
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13
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Aborahma AM. Use of a percutaneous puncture needle for true lumen re-entry during subintimal recanalization of the superficial femoral artery. J Vasc Surg Cases Innov Tech 2016; 2:108-110. [PMID: 38827200 PMCID: PMC11140367 DOI: 10.1016/j.jvscit.2016.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/03/2016] [Indexed: 11/30/2022] Open
Abstract
Failure of subintimal angioplasty commonly results from an inability to re-enter the true lumen. When re-entry devices are not available, an alternative is the retrograde approach. This case report describes three patients with superficial femoral artery occlusion treated by endovascular intervention that showed failure of re-entry into the true lumen after the subintimal approach. In these patients, re-entry was achieved by the use of a percutaneous needle inside the lumen at the proposed re-entry point. This needle creates an aperture in the intima. The antegrade wire is directed to this gap to slide beside the needle and to enter the true lumen.
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Affiliation(s)
- Amr M. Aborahma
- Vascular Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
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14
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15
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Hydrodynamic boost: a novel re-entry technique in subintimal angioplasty of below-the-knee vessels. Eur Radiol 2015; 26:2419-25. [DOI: 10.1007/s00330-015-4078-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/06/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
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16
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Baker AC, Humphries MD, Noll RE, Salhan N, Armstrong EJ, Williams TK, Clouse WD. Technical and early outcomes using ultrasound-guided reentry for chronic total occlusions. Ann Vasc Surg 2015; 29:55-62. [PMID: 25449989 PMCID: PMC9886056 DOI: 10.1016/j.avsg.2014.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/28/2014] [Accepted: 10/18/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subintimal angioplasty is a common treatment for chronic total occlusions (CTOs) in the iliac and infrainguinal arteries. Although technical success has been described using intravascular ultrasound-guided reentry devices (IVUS-RED), outcomes are still not well defined. This report describes the technical aspects and longitudinal follow-up after intravascular ultrasound-guided reentry of iliac and infrainguinal CTOs. METHODS A retrospective review was performed of 20 patients with lower extremity CTO treated with IVUS-RED from 2011 to 2013. A matched cohort of patients who underwent lower extremity interventions without the use of IVUS-RED was also identified. Procedural success, patency estimates, ankle-brachial indices (ABIs), complications, and limb salvage were analyzed. RESULTS Twenty patients (mean age, 69 ± 13 years), including 11 men and 9 women, underwent attempted IVUS-RED-guided recanalization. Median follow-up was 4.3 months (range, 0.4-24). Eleven patients presented with critical limb ischemia (CLI), and 9 presented with claudication. Technical success was achieved in 18 (90%) patients. Ten common iliac arteries, 3 external iliac arteries, and 5 superficial femoral arteries (SFA) were treated. No intraoperative complications resulted from device use. After procedure, ABIs significantly increased (0.5-0.9; P < 0.01) in the 13 patients with follow-up. Primary patency for the entire cohort was 62% at 12 months. No patient treated for claudication required reintervention, whereas 3 (27%) of those treated for CLI required repeat interventions. During follow-up, 2 patients died unrelated to the procedure, 1 patient required an amputation, and 1 patient eventually required open revascularization. When the IVUS-RED group was compared with a cohort matched on Trans-Atlantic Inter-Society Consensus and age, no difference was found in runoff scores and patency between the 2 groups during follow-up (P > 0.05). CONCLUSIONS Recanalization of CTO using IVUS-RED is safe and effective. Use of IVUS-RED does not adversely impact outcomes in conjunction with other endovascular techniques. Early follow-up demonstrates acceptable patency, especially in patients with claudication, and freedom from reintervention.
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Affiliation(s)
- Aaron C. Baker
- Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Misty D. Humphries
- Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Robert E. Noll
- Division of Vascular Surgery, David Grant Medical Center, Travis Air Force Base, CA
| | - Navjeet Salhan
- Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Ehrin J. Armstrong
- Division of Cardiology, VA Eastern Colorado Healthcare System and University of Colorado School of Medicine, Denver, CO
| | - Timothy K. Williams
- Division of Vascular Surgery, David Grant Medical Center, Travis Air Force Base, CA
| | - W. Darrin Clouse
- Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA.,Division of Vascular Surgery, David Grant Medical Center, Travis Air Force Base, CA
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