Re-entry catheters in subintimal lower limb recanalization: up to date

In their daily practice, vascular specialists face the challenge of treating peripheral artery disease (PAD) of the lower limbs. During the last decade, there has been an increasing adoption of endovascular techniques worldwide and a simultaneous expansion of the endovascular instrument portfolio to improve technical results during PAD treatment. The proper use of dedicated endovascular devices is essential to achieve technical success. To know indication, mechanism of action, and possible complications of different devices is of paramount importance to achieve immediate procedural success in the shortest time possible and long-term patency of the treated vessels. All the re-entry catheters on the market are presented with their own unique characteristics. The pros and cons of the use of these devices is also discussed and compared to other possible recanalization strategies. The re-entry devices have been demonstrated to be effective in increasing the procedural success rate, in limiting the dissection of distal healthy vessel segments and shortening the procedural time. They should therefore be considered part of essential tools in the treatment of lower limb chronic total occlusions especially for clinicians who do not feel comfortable in performing retrograde access.