Related Experiment Videos
[Rotation angioplasty--clinical experiences in 83 patients with chronic arterial vascular occlusion]
C Vallbracht1, I Prignitz, D Liermann
1Universitätsklinik Frankfurt und Aggertalklinik, Engelskirchen.
Insights
A novel rotating catheter effectively recanalizes chronic total vascular occlusions, offering a new treatment option for superficial femoral, popliteal, and iliac arteries. This method improves outcomes for patients with severe peripheral artery disease.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Innovation
Background:
- Chronic total vascular occlusions, especially those exceeding 10 cm in superficial femoral and popliteal arteries, present challenges for conventional balloon angioplasty.
- Iliac artery occlusions also have low recanalization rates and high complication rates with standard angioplasty.
Purpose of the Study:
- To evaluate the efficacy of a newly developed slowly rotating, electrically-driven catheter for recanalizing chronic total vascular occlusions.
- To assess the safety and effectiveness of this novel device in treating long-segment occlusions in the superficial femoral, popliteal, and iliac arteries.
Main Methods:
- Development of a flexible, blunt-tipped rotating catheter (2.2 mm outer diameter) designed to navigate occlusions by following the path of least resistance.
- Procedure involved antegrade or retrograde puncture of the common femoral artery, heparin administration, and advancement of the catheter through an 8F sheath via slow rotation (100-200 rpm).
- After confirming intraluminal position and exchanging for a wire, the created channel was dilated.
Main Results:
- The study included 56 patients with superficial femoral artery occlusions, 21 with popliteal artery occlusions, and six with iliac artery occlusions.
- Occlusion lengths ranged from 5 to 35 cm (mean 12.5 cm), with durations of 5 to 48 months.
- Patients presented with Fontaine stages II and IV, and ankle-arm indices between 0 and 0.86 (mean 0.51).
Conclusions:
- The developed rotating catheter demonstrates potential for recanalizing chronic total vascular occlusions previously untreatable with conventional angioplasty.
- This technique offers a promising alternative for patients with extensive peripheral artery disease, potentially improving limb salvage and quality of life.
Abstract:
Chronic, total vascular occlusion represents the limit for use of balloon dilatation. Occlusions of the superficial femoral artery and popliteal artery of more than 10 cm in length have a low recanalization rate of 50 to 60% with conventional angioplasty. In iliac artery occlusions, in addition to a high rate of complications, the recanalization rate is only about 30 to 40%. Starting in 1984, we developed a slowly rotating (100 to 200 r.p.m.), electrically-driven, flexible catheter with a blunt tip, inside lumen and outer diameter of 2.2 mm for the purpose of recanalization (Figure 1). The theoretical basis was that such a catheter would seek the soft occluding thrombus as the path of least resistance. Since 1986, the procedure has been carried out in 56 patients with occlusion of the superficial femoral artery, 21 with occlusion of the popliteal artery and six with occlusion of the iliac artery. The duration of occlusion ranged between five and 48 months and the length of the occlusions between 5 and 35 cm (mean 12.5 cm); the patients were in Fontaine stage II and IV, the ankle arm-index ranged between 0 and 0.86 (mean 0,51). After antegrade or retrograde puncture of the common femoral artery and intra-arterial injection of 5,000 units of heparin, the rotation catheter was advanced through an 8F sheath through the occlusion by means of slow rotation (Figure 2). After contrast medium injection to document the intraluminal position of the catheter and the catheter exchange over a 0.35'' wire, the channel created was dilated.(ABSTRACT TRUNCATED AT 250 WORDS)