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Target Balloon-Assisted Antegrade and Retrograde Use of Re-Entry Catheters in Complex Chronic Total Occlusions
Lorenzo Patrone1, Nada Selva Theivacumar1, Brahman Dharmarajah1,2
1West London Vascular and Interventional Centre, London North West University Healthcare NHS Trust, Harrow HA1 3UJ, UK.
Insights
Target balloon-assisted re-entry devices offer an effective and safe solution for challenging chronic total occlusions when standard methods fail. This approach achieved high technical success and favorable long-term outcomes in patients with complex arterial disease.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Retrograde recanalization is increasingly used for complex arterial occlusive disease.
- Re-entry devices are established adjuncts for antegrade recanalizations.
Purpose of the Study:
- To evaluate the efficacy and safety of target balloon-assisted antegrade and retrograde recanalizations using re-entry devices.
- To assess outcomes in challenging chronic total occlusions where conventional methods failed.
Main Methods:
- Retrospective multicenter registry of 36 patients undergoing target balloon-assisted re-entry.
- Inclusion criteria: antegrade/retrograde use of Outback/GoBack re-entry catheter with a balloon target for wire passage after failed conventional attempts.
- Outcomes assessed: technical success, safety (complications), and 12-month clinical outcomes (amputation-free survival, target lesion revascularization).
Main Results:
- Technical success was achieved in 34 (94%) patients.
- The procedure was performed in patients with claudication and chronic limb-threatening ischemia.
- 12-month amputation-free survival was 87.8%, and freedom from target lesion revascularization was 86.6%.
Conclusions:
- Target balloon-assisted re-entry devices are an effective and safe endovascular adjunct.
- This technique is beneficial when conventional antegrade and retrograde recanalization attempts for chronic total occlusions have failed.
Abstract:
Purpose, Retrograde recanalizations have gained increasing recognition in complex arterial occlusive disease. Re-entry devices are a well described adjunct for antegrade recanalizations. We present our experience with target balloon-assisted antegrade and retrograde recanalizations using re-entry devices in challenging chronic total occlusions.
Materials And Methods:
We report data from a retrospective multicenter registry. Eligibility criteria included either antegrade or retrograde use of the OutbackTM or GoBackTM re-entry catheter in combination with a balloon as a target to accomplish wire passage, when conventional antegrade and retrograde recanalization attempts had been unsuccessful. Procedural outcomes included technical success (defined as wire passage though the occlusion and delivery of adjunctive therapy with <30% residual stenosis at final angiogram), safety (periprocedural complications, e.g., bleeding, vessel injury, or occlusion of the artery at the re-entry site, and distal embolizations), and clinical outcome (amputation-free survival and freedom from target lesion revascularization after 12-months follow-up).
Results:
Thirty-six consecutive patients underwent target balloon-assisted recanalization attempts. Fourteen (39 %) patients had a history of open vascular surgery in the index limb. Fifteen patients were claudications (Rutherford Class 2 or 3, 21 presented with chronic limb threatening limb ischemia (Rutherford Class 4 to 6). The locations of the occlusive lesions were as follows: iliac arteries in 3 cases, femoropopliteal artery in 39 cases, and in below-the-knee arteries in 12 cases. In 15 cases, recanalization was attempted in multilevel occlusions. Retrograde access was attempted in 1 case in the common femoral artery, in the femoropopliteal segment in 10 cases, in below-the-knee arteries in 23 cases, and finally in 2 patients via the brachial artery. In 10 cases, the re-entry devices were inserted via the retrograde access site. Technical success was achieved in 34 (94 %) patients. There were 3 periprocedural complications, none directly related to the target balloon-assisted re-entry maneuver. Amputation-free survival was 87.8 % and freedom from clinically driven target lesion revascularization was 86.6 % after 12-months follow-up.
Conclusion:
Target balloon-assisted use of re-entry devices in chronic total occlusions provides an effective and safe endovascular adjunct, when conventional antegrade and retrograde recanalization attempts have failed.
