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Native chronic total occlusion recanalization after lower limb bypass graft occlusion: A series of nine cases
Author(s) -
Kawarada Osami,
Yokoi Yoshiaki
Publication year - 2010
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.22445
Subject(s) - medicine , surgery , occlusion , revascularization , angioplasty , ankle , bypass surgery , popliteal artery , critical limb ischemia , vascular disease , radiology , myocardial infarction , artery , arterial disease
Objective : The aim of the study was to report the clinical utility of native chronic total occlusion (CTO) recanalization as an endovascular strategy in lower limb bypass graft occlusion. Background : There is no consensus on the best approach for threatened limbs in patients with graft occlusion. Methods : The subjects were nine consecutive patients with limb‐threatening ischemia after bypass graft occlusion. Native CTO recanalization was attempted endovascularly using conventional intraluminal and subintimal angioplasty techniques supported by stents. Results : The mean age of the bypass grafts was 6.7 ± 7.3 (range: 1–24) months and the mean number of previous lower limb bypass surgeries was 1.4 ± 0.5 (range: 1–2). Native CTO recanalization was performed in the iliofemoral ( n = 2), iliac ( n = 2), superficial femoral ( n = 3), popliteal ( n = 1), and popliteal‐tibial ( n = 1) arteries. Technical success was achieved in 89% (8/9) of cases without complications or major adverse cardiovascular events. The ankle‐brachial index and skin perfusion pressure of the foot significantly increased after revascularization, with marked improvement of clinical symptoms (Rutherford class: 4.5 ± 1.1→0.9 ± 1.4, P < 0.001). Limb salvage was achieved in all successful recanalization cases during the mean follow‐up time of 25 ± 20 months (range: 9–60). Conclusions : In this preliminary study, endovascular recanalization of native CTO showed satisfactory outcomes in patients with bypass graft occlusion. © 2010 Wiley‐Liss, Inc.