Endovascular Recanalization of Chronically Occluded Native Arteries After Failed Bypass Surgery in Patients with Critical Ischemia
Minyi Yin1, Wei Wang2, Xintian Huang3
1Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
Insights
Endovascular recanalization of chronic total occlusions (CTO) effectively treats critical limb ischemia (CLI) in patients with failed bypass grafts. This safe procedure offers good limb salvage rates, making it a viable alternative to amputation.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Critical limb ischemia (CLI) with failed lower extremity bypass grafts presents a significant challenge.
- Native chronic total occlusions (CTO) are often implicated in graft failure, limiting revascularization options.
- Endovascular approaches offer a potential alternative for limb salvage in these complex cases.
Purpose of the Study:
- To assess the feasibility, safety, and outcomes of endovascular recanalization for native CTOs in CLI patients with failed bypass grafts.
- To evaluate technical success, complication rates, vessel patency, limb salvage, and survival following the procedure.
Main Methods:
- Retrospective review of 28 CLI patients (28 limbs) with failed lower limb grafts (>30 days post-surgery) undergoing native CTO recanalization.
- Data collected included demographics, procedural details, technical success, complications, vessel patency, limb salvage, and survival rates.
- Follow-up averaged 12.8 months.
Main Results:
- High technical success rate of 92.9% (26/28 limbs).
- Significant improvement in ankle-brachial index post-recanalization.
- At 12 months: primary patency 52.2%, assisted primary patency 65.8%, secondary patency 82.2%, limb salvage rate 91.6%, and amputation-free survival 87.0%.
Conclusions:
- Endovascular recanalization of native CTOs is a feasible, safe, and effective treatment for CLI patients with failed bypass grafts.
- The procedure demonstrates acceptable technical success, vessel patency, and limb salvage rates.
- This endovascular technique should be considered prior to amputation in patients with limited surgical options.
Objective:
The study aimed to evaluate the feasibility, safety, and outcome of endovascular recanalization of native chronic total occlusions (CTO) in patients with critical limb ischemia (CLI) and lower extremities bypass graft failure.
Methods:
A retrospective review of CLI patients with failed lower limb grafts (>30 days after surgery) that underwent recanalization of native CTO was conducted in two institutions from January 2010 to June 2014. Twenty-eight patients (28 limbs) were included in the study, and all had limited surgical revascularization options. Demographics, procedural data, technical success, complications, vessel patency, limb salvage rates, and survival rates were analyzed.
Results:
The mean follow-up period was 12.8 months. The technical success rate was 92.9% (26/28 limbs). The combined ipsilateral antegrade-retrograde approach was performed in nine limbs (32.1%). Major periprocedural (<30 days) complications included two myocardial infarctions (7.1%) and two stent thromboses (7.1%), resulting in one amputation. The ankle brachial index before discharge was significantly improved after recanalization (0.78 ± 0.08 vs. 0.31 ± 0.10, p < 0.01). The primary, assisted primary, and secondary patency rates at 12 months were 52.2, 65.8, and 82.2%, respectively. The limb salvage rate and amputation-free survival rate at 12 months were 91.6 and 87.0%, respectively.
Conclusions:
Endovascular recanalization of native CTO in patients with graft failure-related CLI is a feasible, safe, and effective procedure, with reasonable technical success, vessel patency, and limb salvage rates. The technique should be attempted before amputation in patients with limited surgical revascularization options.
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