Transcutaneous ultrasound-guided endovascular crossing of infrainguinal chronic total occlusions
Subhash Banerjee1, Tony S Das, Emmanouil S Brilakis
1VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX 75230, USA. subhash.banerjee@va.gov <subhash.banerjee@va.gov>
Insights
A new transcutaneous ultrasound-guided (TUG)-CTO technique offers a simpler, safer method for endovascularly treating chronic total occlusions (CTOs) in leg arteries. This approach improves success rates by maintaining an intraluminal path during procedures.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Medical Devices
Background:
- Endovascular treatment of infrainguinal arterial chronic total occlusions (CTOs) is challenging.
- Current methods often involve long procedures, high contrast use, complex dissection, and suboptimal success rates.
- Failure to stay intraluminal or re-enter the true lumen are primary reasons for procedural failure.
Observation:
- A novel technique, transcutaneous ultrasound-guided (TUG)-CTO, was developed for endovascularly crossing totally occluded peripheral arterial segments.
- This technique utilizes transcutaneous ultrasound guidance for precise navigation.
- A blunt-microdissection approach was employed to traverse long segments of superficial femoral artery CTOs.
Findings:
- The TUG-CTO technique is a simple and reproducible method.
- It significantly enhances both the success and safety of endovascular intraluminal crossing of CTOs.
- Successful navigation of long superficial femoral artery CTO segments was achieved.
Implications:
- This technique has the potential to improve outcomes for patients undergoing endovascular treatment for peripheral artery disease.
- It may reduce procedure time, contrast volume, and complexity compared to existing methods.
- Wider adoption of TUG-CTO could enhance the safety and efficacy of infrainguinal CTO interventions.
Abstract:
Currently available techniques for the endovascular treatment of infrainguinal arterial chronic total occlusions (CTOs) require long procedure duration, large contrast volumes, complex subintimal dissection technique, and have low-intermediate success rates. Inability to remain intraluminal and/or reenter the true lumen after subintimal dissection remains the main reasons for procedural failure. We report for the first time a novel, simple, and reproducible technique that can significantly improve both the success and safety of endovascular intraluminal crossing of totally occluded peripheral arterial segments: the transcutaneous ultrasound-guided (TUG)-CTO technique. We used transcutaneous ultrasound guidance to cross long segments of superficial femoral artery CTO using a blunt-microdissection technique.
