Native chronic total occlusion recanalization after lower limb bypass graft occlusion: A series of nine cases

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.