Department of Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.
3rd Department of Vascular Surgery, Athens Medical Center, Athens, Greece.
J Endovasc Ther. 2023 Jun;30(3):433-440. doi: 10.1177/15266028221083456. Epub 2022 Apr 10.
Antegrade wire-catheter crossing remains the primary approach for femoropopliteal interventions. Nonetheless, data reporting on crossing failure are limited. Aim of this study is to identify risk factors for antegrade crossing failure in patients with femoropopliteal chronic total occlusions (CTOs).
This is a single-center, retrospective analysis. Patients with femoropopliteal CTOs treated between May 2018 and February 2020 were included into this study. Primary endpoint of this analysis was primary crossing success defined as successful antegrade crossing without the use of retrograde access, crossing or re-entry devices. The assisted crossing success was additionally analyzed. A logistic regression analysis identified risk factors for failed primary antegrade crossing.
Data from 300 patients were analyzed. The majority (n=183, 61%) presented with lifestyle limiting claudication. The mean lesion length was 180 mm [interquartile range (IQR) 100-260 mm], whereas the median CTO length was 100 mm (IQR=50-210 mm). A chronic total occlusion crossing approach based on plaque morphology (CTOP) type I configuration was observed in 9% (n=26) of the lesions, type II in 61% (n=183), type III in 8% (n=25), and type IV in 66 CTOs (n= 66, 22%). Severe calcification based on the Peripheral Arterial Calcium Scoring Scale (PACSS), Peripheral Academic Research Consortium (PARC), and 360° grading systems was identified in 17%, 24%, and 28% of the lesions, respectively. A contralateral femoral access was used in 278 cases (93%). The primary crossing success amounted to 70% (n=210). The use of a re-entry device in 28 patients (9%) or of a combined antegrade-retrograde approach in 11% (n=34) of the cases increased the assisted crossing success to 89% (n=267). The presence of calcification (odds ratio [OR]=4.2, 95% CI=1.7-10.2) or of circumferential calcium (OR=2.5, 95% CI=1.3-4.9), a CTOP class ΙΙΙ or ΙV (OR=1.9, 95% CI=1.4-2.6), a proximal superficial femoral artery (SFA) occlusion (OR=3.5, 95% CI=1.7-7.4) and a CTO at P3 (OR=4.1, 95% CI=1.5-10.8) were associated with an increased risk for antegrade crossing failure.
In this study, chronic total occlusions (CTO) morphology, calcification burden, and lesion's location were identified as independent risk factors for failed antegrade crossing. Nonetheless, the use of alternative crossing strategies significantly increased the overall crossing success.
顺行导丝导管交叉仍然是股腘动脉介入治疗的主要方法。然而，关于交叉失败的数据报告是有限的。本研究的目的是确定股腘动脉慢性完全闭塞（CTO）患者顺行交叉失败的风险因素。
这是一项单中心回顾性分析。纳入 2018 年 5 月至 2020 年 2 月期间接受股腘动脉 CTO 治疗的患者。本分析的主要终点是定义为成功顺行交叉而无需使用逆行入路、交叉或再进入装置的主要交叉成功率。还分析了辅助交叉成功率。逻辑回归分析确定了主要顺行交叉失败的风险因素。
对 300 名患者的数据进行了分析。大多数（n=183，61%）表现为生活方式受限的跛行。平均病变长度为 180mm[四分位距（IQR）100-260mm]，而中位数 CTO 长度为 100mm（IQR=50-210mm）。基于斑块形态（CTOP）I 型配置的慢性完全闭塞穿越方法在 9%（n=26）的病变中观察到，61%（n=183）为 II 型，8%（n=25）为 III 型，66%（n=66，22%）为 IV 型。根据外周动脉钙评分量表（PACSS）、外周学术研究联盟（PARC）和 360°分级系统，分别在 17%、24%和 28%的病变中发现严重钙化。278 例（93%）采用对侧股动脉入路。主要交叉成功率为 70%（n=210）。在 28 例患者中使用再进入装置（n=28，9%）或在 11%（n=34）的病例中使用顺行-逆行联合方法，辅助交叉成功率增加至 89%（n=267）。钙化的存在（优势比[OR]=4.2，95%置信区间[CI]=1.7-10.2）或环形钙（OR=2.5，95%CI=1.3-4.9）、CTOP 类 III 或 IV（OR=1.9，95%CI=1.4-2.6）、近端股浅动脉（SFA）闭塞（OR=3.5，95%CI=1.7-7.4）和 P3 段 CTO（OR=4.1，95%CI=1.5-10.8）与顺行交叉失败的风险增加相关。
在这项研究中，慢性完全闭塞（CTO）形态、钙化负担和病变位置被确定为顺行交叉失败的独立风险因素。然而，使用替代交叉策略显著提高了整体交叉成功率。
