Raskin Daniel, Khaitovich Boris, Balan Shmuel, Silverberg Daniel, Halak Moshe, Rimon Uri
Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Affiliated to "Sackler" School of Medicine, Tel-Aviv University, 52621, Tel-Aviv, Israel.
Department of Vascular Surgery, Sheba Medical Center, Tel-Hashomer, Affiliated to "Sackler" School of Medicine, Tel-Aviv University, 52621, Tel-Aviv, Israel.
Cardiovasc Intervent Radiol. 2018 Jan;41(1):37-42. doi: 10.1007/s00270-017-1761-7. Epub 2017 Jul 31.
To assess the technical success of the Outback reentry device in contralateral versus ipsilateral approaches for femoropopliteal arterial occlusion.
A retrospective review of patients treated for critical limb ischemia (CLI) using the Outback between January 2013 and July 2016 was performed. Age, gender, length and site of the occlusion, approach site, aortic bifurcation angle, and reentry site were recorded. Calcification score was assigned at both aortic bifurcation and reentry site. Technical success was assessed.
During the study period, a total of 1300 endovascular procedures were performed on 489 patients for CLI. The Outback was applied on 50 femoropopliteal chronic total occlusions. Thirty-nine contralateral and 11 ipsilateral antegrade femoral were accessed. The device was used successfully in 41 patients (82%). There were nine failures, all in the contralateral approach group. Six due to inability to deliver the device due to acute aortic bifurcation angle and three due to failure to achieve luminal reentry. Procedural success was significantly affected by the aortic bifurcation angle (p = 0.013).
The Outback has high technical success rates in treatment of femoropopliteal occlusion, when applied from either an ipsi- or contralateral approach. When applied in contralateral access, acute aortic bifurcation angle predicts procedural failure.
评估Outback再入路装置在股腘动脉闭塞的对侧与同侧入路中的技术成功率。
对2013年1月至2016年7月期间使用Outback治疗严重肢体缺血（CLI）的患者进行回顾性研究。记录患者的年龄、性别、闭塞的长度和部位、入路部位、主动脉分叉角度和再入路部位。在主动脉分叉和再入路部位均进行钙化评分。评估技术成功率。
在研究期间，共对489例CLI患者进行了1300例血管内手术。Outback应用于50例股腘慢性完全闭塞。其中39例采用对侧顺行股动脉入路，11例采用同侧顺行股动脉入路。该装置在41例患者（占82%）中成功使用。有9例失败，均在对侧入路组。6例因急性主动脉分叉角度导致无法输送装置，3例因未能实现管腔再入路而失败。手术成功率受主动脉分叉角度的显著影响（p = 0.013）。
Outback在从同侧或对侧入路治疗股腘动脉闭塞时具有较高的技术成功率。当采用对侧入路时，急性主动脉分叉角度预示手术失败。
