Best crossing of peripheral chronic total occlusions

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiology

Background:

• Peripheral chronic total occlusions (CTOs) present significant challenges in endovascular treatment.
• Current treatment strategies lack standardization, potentially impacting patient and limb outcomes.

Purpose of the Study:

• To introduce and detail a novel, systematic algorithm for the endovascular treatment of peripheral CTOs.
• To enhance the success rates of endovascular procedures and improve patient and limb outcomes through standardized approaches.

Main Methods:

• Development of a multi-disciplinary algorithm by the German Society of Angiology (DGA).
• The algorithm outlines specific steps: imaging for access site selection, CTO cap evaluation, antegrade wiring, decision points for stopping or proceeding, and retrograde/bidirectional techniques.
• Emphasis on guidewire (GW) escalation and advanced reentry devices when needed.

Main Results:

• The proposed algorithm provides a structured approach from diagnosis to treatment completion.
• It details strategies for selecting optimal access, penetrating fibrotic/calcified CTO caps, and managing retrograde access.
• Defines criteria for stopping procedures, including time limits, complications, and contrast administration limits.

Conclusions:

• Adherence to this novel algorithm can standardize endovascular CTO treatment.
• Implementation in daily practice is expected to improve vessel patency and patient-specific outcomes.
• The algorithm aims to increase the success rate of endovascular interventions for peripheral CTOs.