Patrone Lorenzo, Theivacumar Nada Selva, Dharmarajah Brahman, Thulasidasan Narayanan, Diamantopoulos Athanasios, Palena Luis Mariano, Antaredja Muliadi, Tilemann Lisa, Blessing Erwin
West London Vascular and Interventional Centre, London North West University Healthcare NHS Trust, Harrow HA1 3UJ, UK.
Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College, London SW7 2AZ, UK.
J Cardiovasc Dev Dis. 2023 Jan 29;10(2):53. doi: 10.3390/jcdd10020053.
Purpose, Retrograde recanalizations have gained increasing recognition in complex arterial occlusive disease. Re-entry devices are a well described adjunct for antegrade recanalizations. We present our experience with target balloon-assisted antegrade and retrograde recanalizations using re-entry devices in challenging chronic total occlusions.
We report data from a retrospective multicenter registry. Eligibility criteria included either antegrade or retrograde use of the Outback or GoBack re-entry catheter in combination with a balloon as a target to accomplish wire passage, when conventional antegrade and retrograde recanalization attempts had been unsuccessful. Procedural outcomes included technical success (defined as wire passage though the occlusion and delivery of adjunctive therapy with <30% residual stenosis at final angiogram), safety (periprocedural complications, e.g., bleeding, vessel injury, or occlusion of the artery at the re-entry site, and distal embolizations), and clinical outcome (amputation-free survival and freedom from target lesion revascularization after 12-months follow-up).
Thirty-six consecutive patients underwent target balloon-assisted recanalization attempts. Fourteen (39 %) patients had a history of open vascular surgery in the index limb. Fifteen patients were claudications (Rutherford Class 2 or 3, 21 presented with chronic limb threatening limb ischemia (Rutherford Class 4 to 6). The locations of the occlusive lesions were as follows: iliac arteries in 3 cases, femoropopliteal artery in 39 cases, and in below-the-knee arteries in 12 cases. In 15 cases, recanalization was attempted in multilevel occlusions. Retrograde access was attempted in 1 case in the common femoral artery, in the femoropopliteal segment in 10 cases, in below-the-knee arteries in 23 cases, and finally in 2 patients via the brachial artery. In 10 cases, the re-entry devices were inserted via the retrograde access site. Technical success was achieved in 34 (94 %) patients. There were 3 periprocedural complications, none directly related to the target balloon-assisted re-entry maneuver. Amputation-free survival was 87.8 % and freedom from clinically driven target lesion revascularization was 86.6 % after 12-months follow-up.
Target balloon-assisted use of re-entry devices in chronic total occlusions provides an effective and safe endovascular adjunct, when conventional antegrade and retrograde recanalization attempts have failed.
目的，逆行再通在复杂动脉闭塞性疾病中越来越受到认可。再入路装置是顺行再通中一种已被充分描述的辅助手段。我们介绍了在具有挑战性的慢性完全闭塞病变中使用再入路装置进行靶标球囊辅助顺行和逆行再通的经验。
我们报告了一项回顾性多中心注册研究的数据。纳入标准包括在传统顺行和逆行再通尝试失败时，顺行或逆行使用Outback或GoBack再入路导管并联合球囊作为靶标以完成导丝通过。手术结果包括技术成功（定义为导丝通过闭塞段并在最终血管造影时残余狭窄<30%时进行辅助治疗）、安全性（围手术期并发症，如出血、血管损伤、再入路部位动脉闭塞或远端栓塞）以及临床结果（12个月随访后的无截肢生存率和免于靶病变血管重建）。
36例患者连续接受靶标球囊辅助再通尝试。14例（39%）患者在患侧肢体有开放血管手术史。15例为间歇性跛行患者（卢瑟福分级2或3级），21例表现为慢性肢体威胁性缺血（卢瑟福分级4至6级）。闭塞病变的位置如下：髂动脉3例，股腘动脉39例，膝下动脉12例。15例患者尝试进行多级闭塞的再通。在1例患者中尝试经股总动脉逆行入路，在股腘段10例，在膝下动脉23例，最后在2例患者中经肱动脉入路。10例患者经逆行入路部位插入再入路装置。34例（94%）患者获得技术成功。有3例围手术期并发症，均与靶标球囊辅助再入路操作无直接关系。12个月随访后，无截肢生存率为87.8%，免于临床驱动的靶病变血管重建率为86.6%。
当传统顺行和逆行再通尝试失败时，在慢性完全闭塞病变中靶标球囊辅助使用再入路装置提供了一种有效且安全的血管内辅助手段。
