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Endovascular recanalization of native chronic total occlusions in patients with failed lower-extremity bypass grafts
Clinton W Wrigley1, Ansar Vance1, Timothy Niesen1
1Department of Interventional Radiology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718.
Insights
Endovascular recanalization of chronic total occlusions (CTOs) in legs with failed bypass grafts is safe and effective. This procedure offers a viable option for limb salvage in complex peripheral artery disease cases.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Lower-extremity bypass grafts often fail, leading to critical limb ischemia.
- Restoring perfusion in native arteries is crucial for limb salvage when bypass fails.
Purpose of the Study:
- To assess the feasibility, safety, and outcomes of endovascular recanalization for native chronic total occlusions (CTOs) in patients with failed lower-extremity bypass grafts.
Main Methods:
- Retrospective review of 19 limbs in 18 patients with failed bypass grafts undergoing native arterial recanalization.
- Analysis of technical success, patency rates, and limb salvage outcomes.
Main Results:
- High technical success rate (95%) for endovascular recanalization.
- Significant improvement in ankle-brachial index (0.34 to 0.73).
- Acceptable primary and secondary patency rates, with 12-month limb salvage at 94%.
Conclusions:
- Endovascular recanalization of native CTOs is a feasible and safe option for patients with failed lower-extremity bypass grafts.
- The procedure demonstrates acceptable limb salvage rates, offering an alternative to repeat bypass or amputation.
Purpose:
To investigate the feasibility, safety, and outcome of endovascular recanalization of native chronic total occlusions (CTOs) in patients with failed lower-extremity bypass grafts.
Materials And Methods:
Retrospective review of 19 limbs in 18 patients with failed lower-extremity bypass grafts that underwent recanalization of native arterial occlusions between February 2009 and April 2013 was performed. Nine of the limbs presented with acute ischemia and 10 presented with chronic ischemia, including eight with critical limb ischemia and two with disabling claudication.
Results:
The mean patency of the failed bypass grafts (63% venous) was 27 months. All limbs had Transatlantic Inter-Society Consensus class D lesions involving the native circulation. Technical success of the endovascular recanalization procedure was achieved in all but one limb (95%). The mean ankle brachial indices before and after treatment were 0.34 and 0.73, respectively. There were no major complications or emergency amputations. Mean patient follow-up was 64 weeks, and two patients were lost to follow-up. Primary patency rates at 3, 6, and 12 months were 87%, 48%, and 16%, respectively. Successful secondary procedures were performed in seven patients, with secondary patency rates at 3, 6, and 12 months of 88%, 73%, and 44%, respectively. Limb salvage rates at 12 and 24 months were 94% and 65%, and amputation-free survival rates at 12 and 24 months were 87% and 60%, respectively.
Conclusions:
Endovascular recanalization of native CTOs in patients with failed lower-extremity bypass grafts is technically feasible and safe and results in acceptable limb salvage.
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