Long Chronic Total Occlusions: Revascularization Strategies

Sheeran, D.; Wilkins, Lippincott Williams

doi:10.1055/s-0038-1676343

Cited by 14 publications

(14 citation statements)

References 29 publications

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“…The appropriate selection of the access site for a PAOD is one of the most important factors to obtain a successful guidewire recanalization [2]. This time, we first report the feasibility and…”

Section: Discussionmentioning

confidence: 95%

“…Guidewire crossing techniques for peripheral artery occlusive disease (PAOD) including the bi-directional approach technique for aorto-iliac and femoro-popliteal artery (FP) occlusive lesion are developing [1]. In general, the open vessel puncture is the standard choice as antegrade/retrograde approach site for PAOD [2]. However, some complex cases do not have appropriate approach sites due to multi-level lesions or some anatomical issues.…”

Section: Introductionmentioning

confidence: 99%

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Direct occluded vessel puncture technique as a new access site for complex peripheral artery occlusive disease

Yamada

Kawasaki

2020

Journal of Cardiology Cases

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A 77-year-old male was admitted to our hospital for severe intermittent claudication of both legs. He was diagnosed with aorto-iliac occlusions and a right femoro-popliteal artery occlusion with a diseased common femoral artery by a computed tomography angiography of the lower limb. We planned endovascular therapy for these multi-level occlusive lesions. The aorto-iliac lesion of the left side was antegradely recanalized via the left brachial artery. That of the right side was recanalized retrogradely by a direct occlusive vessel puncture (DOVP) with a dedicated 20 G needle and the Hi-Torque Command 18 ST. After stenting, his symptoms were completely relieved without revascularization of right femoropopliteal artery, and he was discharged without any complications. The DOVP may also be used as an alternative option when there is not an appropriate approach site.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Direct occluded vessel puncture technique as a new access site for complex peripheral artery occlusive disease

Yamada

Kawasaki

2020

Journal of Cardiology Cases

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“…The appropriate selection of the access site for PAOD is one of the most important factors for successful guidewire recanalization 4) . We first report the feasibility and safety of the direct occluded vessel puncture technique in combination with a dedicated 20 G needle and the Hi-Torque Command 18 ST for patients without appropriate access sites.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, guidewire crossing techniques have been developed for peripheral artery occlusive disease (PAOD), and one of these techniques is the bidirectional approach for aortoiliac and femoropopliteal occlusive lesions [1][2][3] . In general, puncturing a vessel to access the lumen is the standard choice in the antegrade and/or retrograde approach for PAOD 4) . However, some complex cases do not have appropriate approach sites because of multilevel lesions or anatomical issues.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Safety of the Direct Occluded Vessel Puncture Technique as a New Access Site for Complex Peripheral Artery Occlusive Disease

Kawasaki

Yamada

Fukunaga

2021

JAT

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This study aims to describe the feasibility and safety of direct occluded vessel puncture as a new access site for complex peripheral artery occlusive disease.Methods: Eleven consecutive patients with symptomatic peripheral artery disease underwent endovascular therapy using the direct occluded vessel puncture technique. The occluded vessel was punctured using a dedicated 20 G needle and the Hi-Torque Command 18 ST guidewire under duplex echo or fluoroscopic guidance, and a 6 Fr sheath was then inserted. Hemostasis was achieved with the Exoseal ® Vascular Closure Device.Results: Direct occluded vessel puncture was achieved in 10 of 11 cases (90.9%), and procedural success was achieved in all cases. There were no in-hospital deaths or any complications, including bleeding, pseudoaneurysms, thrombosis, or surgical conversion. Conclusion:The direct occluded vessel puncture technique using a 20 G needle and the Hi-Torque Command 18 ST is feasible and safe. This technique may also be used as an alternative option when there are no appropriate approach sites. AimThis study was conducted to evaluate the feasibility and safety of the direct occluded vessel puncture technique in the creation of a new access site for complex PAOD. Methods Patient PopulationA total of 82 symptomatic patients with aortoiliac and/or femoropopliteal chronic total occlusion (CTO) underwent endovascular therapy (EVT) in our hospital between August 2019 and February 2020. Direct occluded vessel puncture was attempted in 11 patients (5 men; mean age: 74.8 8.4 years) to recanalize the complex CTO lesion after unsuccessful standard antegrade recanalization because there was no Copyright©2021 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

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“…The intraluminal technique was performed prior to the subintimal technique because, if successful, its response to the balloon was more favourable, but it took more time [7]. The subintimal technique is known for its superiority in long occlusions and patency because it is faster, and has a higher technical success, as well as high limb salvage rates [8,9]. The false lumen created by this technique rarely develops into recurrent stenosis because it does not consist of endothelium and atheroma.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Surgery or Both: A Case Report of Hybrid Procedure in a Patient with Abdominal Aortic Aneurysm and Tasc D Aortoiliac Occlusive Disease

Laksono¹,

Pasciolly²,

Prawara³

2020

TOCMJ

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Hybrid procedure, a combination of endovascular and open surgical approach, has emerged as the first-line treatment for patients with severe aortoiliac diseases because of its effectiveness. We report a hybrid procedure in a 72 year old man with an Abdominal Aortic Aneurysm (AAA) and Trans-Atlantic Inter-Society Consensus (TASC) D aortoiliac occlusive disease. After two failed attempts using the intraluminal technique (retrograde and antegrade), we successfully performed an endovascular approach with subintimal and Subintimal Arterial Flossing Antegrade-retrograde Intervention (SAFARI) technique with the help of roadmap technology. The vascular surgeon completed the procedure by creating femorofemoral bypass using a Great Saphenous Vein (GSV) graft. The graft was patent and there were no complications at 1 week, 1 month and 6 months follow-up.

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Long Chronic Total Occlusions: Revascularization Strategies

Cited by 14 publications

References 29 publications

Direct occluded vessel puncture technique as a new access site for complex peripheral artery occlusive disease

Direct occluded vessel puncture technique as a new access site for complex peripheral artery occlusive disease

Feasibility and Safety of the Direct Occluded Vessel Puncture Technique as a New Access Site for Complex Peripheral Artery Occlusive Disease

Endovascular Surgery or Both: A Case Report of Hybrid Procedure in a Patient with Abdominal Aortic Aneurysm and Tasc D Aortoiliac Occlusive Disease

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