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Crossing of infrainguinal peripheral arterial chronic total occlusion with a blunt microdissection catheter
Subhash Banerjee1, Rahul Thomas, Karan Sarode
1University of Texas Southwestern Medical Center, Dallas, Texas 75216 USA. subhash.banerjee@va.gov.
Insights
The Viance device effectively crosses challenging lower-extremity arterial chronic total occlusions (CTO), demonstrating high technical success and significant patient symptom improvement. This study highlights its safety and efficacy in peripheral artery interventions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Chronic total occlusions (CTO) in the lower extremities pose significant challenges for endovascular treatment.
- Limited studies have evaluated the efficacy of specific devices for crossing these complex lesions.
Purpose of the Study:
- To assess the safety and effectiveness of the Viance peripheral CTO crossing device for treating infrainguinal arterial CTOs.
- To evaluate procedural success rates and clinical outcomes in patients undergoing intervention for lower-extremity CTOs.
Main Methods:
- A retrospective analysis of 58 patients from the Excellence in Peripheral Artery Disease (XLPAD) registry treated with the Viance device.
- Data collected included procedural success, technical success, complication rates, and 30-day clinical outcomes.
Main Results:
- High technical success (87.9%) and procedural success (86.2%) were achieved in crossing infrainguinal CTOs.
- Significant improvements were observed in ankle-brachial index (P=.01) and Rutherford class (P<.001) at 30 days.
- A low rate of periprocedural complications (1.7%) was reported, with no major adverse events.
Conclusions:
- The Viance device is a safe and effective tool for crossing infrainguinal arterial CTOs.
- Its use is associated with high success rates and significant improvement in patient symptoms and functional status.
- Further research may support its broader application in complex peripheral artery disease interventions.
Purpose:
Crossing of lower-extremity arterial chronic total occlusion (CTO) can be challenging. Use of the Viance peripheral CTO crossing device (Covidien) in the superficial femoral (SFA), popliteal, and below-the knee (BTK) arterial locations has received limited study.
Methods:
Fifty-eight patients from the Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851) were treated between April 2010 and November 2013 with the Viance device. The procedural and 30-day clinical outcomes were collected.
Results:
Mean age was 65.5 ± 8.7 years and 55.1% had diabetes mellitus. Most lesions (n = 58) were TASC classification type C (n = 16; 27.6%) and D (n = 16; 27.6%), with mean lesion length 140.0 ± 71.0 mm; 93.1% of lesions were de novo and 81.0% were severely calcified. Technical success (crossing without the use of a reentry device) was achieved in 87.9% of cases and procedural success was obtained in 86.2%; 51.7% of lesions received stents, with the remaining treated with balloon angioplasty and/or atherectomy. Average fluoroscopy time was 39.1 ± 21.2 min, with 187.8 ± 72.0 mL of contrast and 210.0 ± 212.0 Gy cm² radiation dose-area product. There was 1 periprocedural complication (access-site hematoma treated conservatively without blood transfusion). At 30 days post procedure, there was significant improvement in ankle-brachial index (0.72 ± 0.30 to 0.84 ± 0.16; P=.01) and Rutherford class (3.33 ± 0.81 to 1.54 ± 1.47; P<.001). Clinically-indicated target vessel revascularization, surgical intervention or amputation at 30 days was 5.2%.
Conclusion:
Use of Viance to cross infrainguinal arterial CTO was associated with high success, low complication rates, and significant symptom improvement.
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