The Use of Re-entry Devices in Aortoiliac Occlusive Disease

Abstract

Endovascular approach is the first-choice treatment in patients suffering from aortoiliac occlusions. Nevertheless, standard endoluminal revascularization fails in treating occlusions in about 20% ( 1 ) of cases. Thus, subintimal revascularization can be a solution, but it fails in 25% ( 2 ) of cases as well. In the last decades, different devices have been created, in order to ease the cross back into the true lumen, when standard subintimal revascularization does not work or risks to occlude important collateral vessels. Herein, we revise the currently available re-entry devices and their application in the aortoiliac occlusive pathology.

A novel approach to deep venous arterialization using WavelinQ EndoAVF technology

“…Heavy calcification is a limitation for all reentry devices, including the WavelinQ system. 11 The cost of the WavelinQ is another factor. Although it is unclear how the cost will compare to that of the LimFlow system once it becomes commercially available in Australia, it is currently more expensive than most standard reentry devices on the market.…”

Pioneer re-entry into covered stent graft to recanalize occluded, jailed external iliac artery

“…The Pioneer re-entry catheter has been demonstrated effective in treating iliac occlusions, with improved technical success in iliac revascularization, but has not been demonstrated in the literature in the manner of re-entering an existing covered stent, and in conjunction with hypogastric preservation. 11 , 12 Hypogastric preservation is important, because 25% of patients with unilateral internal iliac artery sacrifice will have buttock claudication and 50% of these patients will have persistent symptoms that significantly decreases their quality of life. Other severe complications can occur with internal iliac artery sacrifice, including spinal cord ischemia and ischemic colitis.…”

Percutaneous Intentional Extraluminal Recanalization of Chronic Total Occlusions: A Review of Reentry Devices

“…Potential disadvantages of the catheter include difficulties tracking over narrow aortic bifurcations during contralateral access, trouble tracking over the wire crossing calcified occlusions in spite of the catheter's hydrophilic coating, and difficulty with piercing calcified plaque at the reentry site. 30 Occasionally, the needle spins during needle deployment or deflects off the plaque, resulting in improper location of the puncture. In addition, there are anecdotes of the direction of the curved needle not precisely aligning with the orientation of the aforementioned “T” and “L” markers, due to catheter angulation over the bifurcation and within the distal vessels.…”