Targeted tibio-peroneal re-entry during subintimal revascularization using the Outback® catheter
1Department of Diagnostic and Interventional Radiology, University hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany. katharina.rippel@uk-augsburg.de.
Insights
The Outback® re-entry device effectively achieves true lumen access in tibio-peroneal arteries, improving outcomes for patients with critical limb ischemia. This study demonstrates its high success rate in challenging cases.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Re-entry devices are crucial for subintimal recanalization of chronic arterial occlusions.
- Their application in tibio-peroneal arteries is less documented.
- This study evaluates the Outback® device for tibio-peroneal true lumen access.
Purpose of the Study:
- To retrospectively evaluate the efficacy of the Outback® re-entry device.
- To assess its use for targeted true lumen access in tibio-peroneal arteries.
- To determine its role in cases of failed spontaneous re-entry.
Main Methods:
- Retrospective analysis of 14 patients using the Outback® catheter (9/2017-10/2020).
- Device used for failed spontaneous re-entry in tibio-peroneal arteries.
- Data collected included demographics, occlusion characteristics, procedural success, and SVS runoff scores.
Main Results:
- Successful technical and procedural re-entry in all 14 patients (Rutherford stage 4-6).
- Median re-entry accuracy of 0.25 cm.
- Significant improvement in SVS runoff score (14.5 to 7, p<0.01).
Conclusions:
- The Outback® catheter demonstrates high technical and procedural success for tibio-peroneal re-entry.
- It is a valuable option when other recanalization methods fail.
- Consideration for complex tibio-peroneal interventions is recommended.
Background:
Re-entry devices are used regularly in subintimal recanalization of chronic occlusions of the iliac and femoro-popliteal arteries and significantly contribute to the high success rate of these interventions. However, the use in tibio-peroneal arteries has only been described in few cases so far. The present work is a retrospective evaluation of the Outback® re-entry device for gaining targeted true lumen access at the level of the tibio-peroneal arteries.
Methods:
From 9/2017 until 10/2020 the Outback® catheter was used in case of failed spontaneous re-entry at the level of the tibio-peroneal arteries in 14 patients either instead of the usual retrograde approach via a pedal/distal-crural access (n = 11) or in combination with it (n = 3). Baseline demographic and clinical data, morphologic characteristics of the occlusions, procedural succedss, as well as the Society of Vascular Surgery (SVS) runoff score before and after revascularization were documented.
Results:
All patients (median age: 78 years; range: 66-93) suffered from peripheral artery occlusive disease Rutherford stage 4 to 6 with a median lesion length of 12 cm (range: 7-35). Technical and procedural success was achieved in all 14 patients. The mean re-entry accuracy was 0.25 cm (range: 0-0.8). The SVS runoff score improved from a median of 14.5 (interquartile range IQR: 10.8-16.4) to 7 (IQR: 6.3-7) (p < 0.01).
Conclusions:
The use of the Outback® catheter for targeted tibio-peroneal re-entry is associated with a high technical and procedural success rate and should be considered in case of otherwise failed ante- and retrograde recanalization.
