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A Percutaneous Crossing Algorithm for Femoropopliteal and Tibial Artery Chronic Total Occlusions (PCTO Algorithm)

Subhash Banerjee1, Mehdi H Shishehbor, Jihad A Mustapha

  • 1Dallas VA Medical Center, 4500 S. Lancaster Road (111a), Dallas, TX 75216 USA. subhash.banerjee@utsouthwestern.edu.

The Journal of Invasive Cardiology
|March 31, 2019
PubMed

Insights

This review presents an ultrasound-guided strategy for crossing femoropopliteal peripheral artery chronic total occlusions (PCTOs). The approach aims to improve procedural success and patient safety in endovascular interventions for peripheral artery disease.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Medical Imaging

Background:

  • Peripheral artery chronic total occlusions (PCTOs) present a significant challenge in endovascular interventions.
  • Successful crossing of PCTOs is critical for procedure success and complication avoidance.

Purpose of the Study:

  • To outline a contemporary, ultrasound-based approach for crossing femoropopliteal (FP) PCTOs.
  • To provide a systematic strategy for optimizing guidewire selection and re-entry techniques.

Main Methods:

  • Review of prospectively collected case reports, published evidence, and expert consensus.
  • Description of optimal imaging and key angiographic/ultrasound features.
  • Development of a hierarchical procedural algorithm.

Main Results:

  • Detailed guidance on lesion imaging and selection of antegrade, retrograde, or hybrid crossing techniques.
  • Strategies for initial guidewire selection, escalation, and dissection re-entry.
  • Case examples illustrating the application of the described methods.

Conclusions:

  • The proposed ultrasound-based algorithm provides a systematic strategy for crossing PCTOs.
  • Implementation of this approach can enhance crossing efficiency, treatment success, and patient safety.

Keywords:
chronic total occlusionperipheral artery disease

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