Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital.
Department of Cardiovascular Surgery, Morinomiya Hospital.
J Atheroscler Thromb. 2017 Dec 1;24(12):1242-1248. doi: 10.5551/jat.40048. Epub 2017 May 17.
A successful antegrade wire crossing for femoro-popliteal chronic total occlusion (FP-CTO) is still a technical challenge. We attempted to demonstrate the safety and feasibility of the OUTBACK Elite reentry catheter and the bi-directional approach for failed FP-CTO cases with the antegrade approach.
Endovascular therapy for FP-CTO was performed in 219 lesions from May 2013 to December 2016 at Morinomiya Hospital. We retrospectively analyzed the data of 43 consecutive lesions which underwent endovascular therapy using the bi-directional approach with distal access and the mono-directional approach with the OUTBACK Elite reentry catheter for FP-CTO lesions. The antegrade success using a combination of traditional and Intravascular Ultrasound (IVUS) -guided techniques was achieved in 170 lesions out of a total of 219 lesions. From May 2013 to June 2016 (phase 1), the bi-directional approach with distal access was applied to 22 lesions after failed antegrade approaches. From July 2016 to December 2016 (phase 2), the mono-directional approach with the OUTBACK Elite reentry catheter was applied to 21 lesions.
Clinical and lesion characteristics in phase 1 were not significantly different from those in phase 2. The overall initial technical success rate was 100% in both phases. The total wire number and amount of contrast media were significantly less, and the total procedure time and the total fluoroscopic time were significantly shorter in phase 2 than in phase 1 (p＜0.01).
Endovascular therapy for FP-CTO using the OUTBACK Elite reentry catheter is feasible and safe after a failed antegrade approach.
股腘动脉慢性完全闭塞（FP-CTO）正向导丝穿越仍然是一个技术挑战。我们试图展示 OUTBACK Elite 再进入导管和双向入路在正向入路失败的 FP-CTO 病例中的安全性和可行性。
2013 年 5 月至 2016 年 12 月，在森野综合医院对 219 例 FP-CTO 病变进行了血管内治疗。我们回顾性分析了 43 例连续病变的资料，这些病变采用双向入路经远端入路和单向入路经 OUTBACK Elite 再进入导管治疗 FP-CTO 病变。在总共 219 例病变中，有 170 例采用传统和血管内超声（IVUS）引导技术相结合的正向方法获得了成功。2013 年 5 月至 2016 年 6 月（第 1 阶段），在正向入路失败后，应用双向入路经远端入路治疗 22 例病变。2016 年 7 月至 2016 年 12 月（第 2 阶段），应用 OUTBACK Elite 再进入导管进行单向入路治疗 21 例病变。
第 1 阶段和第 2 阶段的临床和病变特征无显著差异。两个阶段的初始技术成功率均为 100%。第 2 阶段的总导丝数量和造影剂用量明显减少，总手术时间和总透视时间明显缩短（p＜0.01）。
在正向入路失败后，应用 OUTBACK Elite 再进入导管治疗 FP-CTO 是可行和安全的。
