Kinariwala Dhara, Taylor Amy C, Wilkins Luke R
Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia.
Semin Intervent Radiol. 2023 Jun 16;40(2):144-150. doi: 10.1055/s-0043-57260. eCollection 2023 Apr.
Percutaneous intentional extraluminal recanalization (PIER) is an endovascular subintimal crossing technique used to treat chronic total occlusions (CTOs) of the peripheral arteries. Intraluminal revascularization remains the standard over PIER when technically feasible; however, when intraluminal approaches fail, PIER may be preferred prior to pursuit of surgical bypass grafting. The major cause of failure of PIER is inability to reenter the true lumen after crossing the CTO. Therefore, several reentry devices and endovascular techniques have been developed to allow for the operators to safely and quickly access the true lumen distal to the occlusion. Reentry devices currently available on the market include the Pioneer Plus catheter, Outback Elite catheter, OffRoad catheter, Enteer catheter, and GoBack catheter. These devices have unique methods of use and specific advantages with regard to their technical success along with reduced procedural and fluoroscopic time. In addition, there are other endovascular techniques available that may facilitate true lumen reentry and these will also be reviewed.
经皮意向性腔外再通术（PIER）是一种血管腔内内膜下穿越技术，用于治疗外周动脉慢性完全闭塞（CTO）。在技术可行的情况下，腔内血管重建仍是优于PIER的标准治疗方法；然而，当腔内治疗方法失败时，在考虑进行外科搭桥手术之前，PIER可能是更可取的选择。PIER失败的主要原因是在穿越CTO后无法重新进入真腔。因此，已经开发了几种再入路装置和血管腔内技术，以使操作者能够安全、快速地进入闭塞远端的真腔。目前市场上可用的再入路装置包括先锋加导管、Outback Elite导管、OffRoad导管、Enteer导管和GoBack导管。这些装置具有独特的使用方法，在技术成功率方面具有特定优势，同时减少了手术时间和透视时间。此外，还有其他可用的血管腔内技术，可能有助于重新进入真腔，本文也将对这些技术进行综述。
