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Published on: January 18, 2018
Impact of aggressive endovascular recanalization techniques on success rate in chronic total arterial occlusions
Melhem J Sharafuddin1, Jamal J Hoballah, Timothy F Kresowik
1Department of Surgery, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA 52242, USA. mel-sharafuddin@uiowa.edu
Insights
Aggressive recanalization techniques for chronic total arterial occlusion (CTO) significantly improve success rates when traditional methods fail. These advanced approaches are safe and effective for complex arterial blockages.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Chronic total arterial occlusion (CTO) presents significant challenges in vascular interventions.
- Traditional recanalization methods have limitations in achieving successful outcomes for complex CTOs.
Purpose of the Study:
- To evaluate the efficacy and safety of aggressive recanalization strategies for CTO.
- To report procedural success rates using advanced techniques after conventional methods failed.
Main Methods:
- A retrospective analysis of 112 limbs in 99 patients with CTOs treated between 1999 and 2006.
- Initial attempts used conventional recanalization, followed by aggressive techniques like stiff guidewire probing and directional sharp needle recanalization if needed.
Main Results:
- Conventional recanalization succeeded in 70% of cases.
- Aggressive techniques, including guidewire probing and needle recanalization, increased the overall success rate to 88%.
- Complications were minor and managed nonoperatively.
Conclusions:
- Aggressive recanalization techniques are a safe and effective adjunct to traditional methods for CTO.
- These advanced approaches substantially improve procedural success rates in challenging arterial occlusions.
Purpose:
To report experience with aggressive recanalization approaches in chronic total arterial occlusion (CTO).
Methods:
Chronic total arterial occlusion recanalization was attempted on 112 limbs in 99 consecutive patients between January 1999 and December 2006.
Results:
There were 63 iliac arteries, 45 femoropopliteal arteries, and 4 occluded stents. Mean occlusion length was 8.7 ± 4.7 cm. Conventional recanalization was attempted first and was successful in 71 limbs (70%). Probing with the guidewire's stiff end was attempted in 33 of the 41 procedures where conventional techniques failed and was successful in 18 (54%), improving the overall procedural success rate to 80%. For the remaining 15 limbs, home-made directional sharp needle recanalization was attempted in 11 and was successful in 9 (82%), further improving the overall recanalization success to 88%. Procedural complications were self-limited or managed nonoperatively.
Conclusions:
Aggressive recanalization techniques in CTO following failure of traditional means are safe and can substantially improve procedural success rates.
