Outcome and Distal Access Patency in Subintimal Arterial Flossing with Antegrade-Retrograde Intervention for Chronic
Kun Da Zhuang1, Ankur Patel1, Bien Soo Tan1
1Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore.
Insights
The Subintimal Arterial Flossing with Antegrade-Retrograde Intervention (SAFARI) technique offers a safe and effective solution for treating chronic total occlusions (CTOs) in critical limb ischemia (CLI). This method demonstrates good outcomes and maintains distal access patency, improving limb salvage rates.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Critical limb ischemia (CLI) poses a significant threat to limb viability.
- Chronic total occlusions (CTOs) are a common challenge in treating CLI.
- Antegrade revascularization techniques may fail, necessitating alternative approaches.
Purpose of the Study:
- To evaluate the outcomes of the Subintimal Arterial Flossing with Antegrade-Retrograde Intervention (SAFARI) technique.
- To assess distal access patency following SAFARI procedures for CTOs in CLI patients.
- To determine the safety and efficacy of SAFARI as a treatment for CLI.
Main Methods:
- A retrospective analysis of 220 SAFARI procedures performed between January 2009 and June 2015.
- Patients with CLI (Fontaine classification 3 and 4) underwent the SAFARI technique for CTOs.
- Outcome measures included technical success, freedom from major amputation, complication rates, and distal access patency.
Main Results:
- Technical success was achieved in 80.5% of cases.
- Freedom from major amputation was 84.7% at 6 months, 82.9% at 12 months, and 81.9% at 24 months.
- Distal access remained patent in 80.8% of cases undergoing repeat intervention, with a low complication rate.
Conclusions:
- The SAFARI technique is a safe and effective treatment for CTOs in CLI patients.
- This retrograde approach provides a viable option when antegrade revascularization fails.
- SAFARI contributes to limb salvage and improved outcomes in complex vascular interventions.
Purpose:
To report the outcome and distal access patency of the Subintimal Arterial Flossing with Antegrade-Retrograde Intervention (SAFARI) technique for chronic total occlusion (CTO) in critical limb ischemia (CLI).
Materials And Methods:
From January 2009 to June 2015, 220 SAFARI procedures were performed for 200 limbs in 191 patients (108 males [56.5%]; median age, 70 years old; range, 36 to 97 years old) with CLI (9.4% were Fontaine classification 3; and 90.6% were Fontaine classification 4). Distal access was obtained from the distal superficial femoral artery (n = 6), popliteal artery (n = 49), anterior tibial artery (n = 56), dorsalis pedis (n = 51), peroneal artery (n = 12), posterior tibial artery (n = 45), and lateral plantar artery (n = 1). Distal access hemostasis was obtained with internal balloon tamponade in 71.4% (n = 157). Outcome measurements were technical success, freedom from major amputation and complications. Preprocedural angiograms of clinically driven repeat interventions were reviewed in 73 cases for distal access patency.
Results:
Technical success was achieved in 80.5% (n = 177). Reasons for technical failure include inability to obtain distal access (n = 3), cross the occlusion retrogradely (n = 16), re-enter the true lumen (n = 9), and achieve antegrade blood flow after the procedure (n = 15). Freedom from major amputation for technically successful procedures was 84.7%, 82.9%, and 81.9% at 6, 12, and 24 months, respectively. There were 3 cases of distal access bleeding with 1case that required coil embolization. The distal access remained patent in 80.8% of observable cases with repeated endovascular intervention.
Conclusions:
Distal retrograde arterial access (SAFARI) technique is safe and effective in the treatment of CTOs in the context of CLI, after failure of antegrade revascularization.
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation