True lumen re-entry after extravascular recanalization of a superficial femoral artery chronic total occlusion

Wagner, Jason K.; Chaer, Rabih A.; Rhee, Robert Y.; Marone, Luke

doi:10.1016/j.jvs.2010.01.082

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…One resulted in extravascular revascularization of the femoropopliteal lesion and has been reported independently. 8 Similar to other reports, failure to achieve successful endoluminal therapy was most often due to failure of the device to re-enter the true lumen. 2,[4][5][6][7] The current review has identified heavy calcification at the proposed re-entry site as the primary reason for device failure.…”

Section: Discussionsupporting

confidence: 75%

Limitations of the Outback LTD re-entry device in femoropopliteal chronic total occlusions

Shin

Baril

Chaer

et al. 2011

Journal of Vascular Surgery

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Section: Discussionsupporting

confidence: 75%

Limitations of the Outback LTD re-entry device in femoropopliteal chronic total occlusions

Shin

Baril

Chaer

et al. 2011

Journal of Vascular Surgery

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“…Others have reported success using this technique. 7,8 Unfortunately, this method has a major limitation: The antegrade and retrograde catheters must lie in close proximity (ideally ≤5 mm) to one another given the short throw of the reentry device needle. Once the catheters are extravascular, maintaining this proximity is challenging, and technical failure occurs when the catheters cannot be steered.…”

Section: Discussionmentioning

confidence: 99%

Extravascular Revascularization of a Chronic Total Occlusion Using the Dual Bull’s-Eye Technique

Kahn

Kaufman

2016

J Endovasc Ther

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“…Isolated reports have highlighted the rare delayed occurence of extravasation/perforation following nitinol selfexpanding stent placement in long segments of subintimal passage [4]. In such cases, the upfront use of a covered stent [Viabahn, Gore (Newark, DE)] may be helpful.…”

mentioning

confidence: 99%

Finding your way back: Wires, loops, needles and balloons

Ahmed

Prasad

2013

Cathet Cardio Intervent

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As we make advances in percutaneous peripheral interventions, operators have embraced challenging cases utilizing new techniques and tools. Chronic total occlusions (CTOs), especially long segments of occlusion in the lower extremity is one such challenge. From a procedural standpoint, the ideal approach to recanalizing CTOs has been to traverse the occluded segment with the goal of staying within the true lumen. However, many cases either require subintimal passage to avoid calcification or instead result in unwanted subintimal entry.Bolia et al.[1] first described the technique of creating a subintimal channel and tracking the wire with an attempt to re-enter the distal true lumen. This maneuver is performed by using the "wire loop" technique that involves creating a prolapsed wire loop in the subintimal space and advancing it in this plane with the support of a catheter. Regardless of the intent, re-entry is the final common step to a successful case. Several dedicated re-entry tools have been developed ranging from fluoroscopic or intravascular ultrasound guided puncture needles [Outback (Cordis, Bridgewater, NJ) and Pioneer (Medtronic, Minneapolis, MN)] to balloon supported re-entry wires [Enteer (Covidien, Mansfield, MA)].In this issue of CCI, Aslam et al.[2] report very high success rate (96%) with the use of Outback LTD Re-Entry Catheter. The authors describe their experience with the Outback system for re-entry in a variety of lower extremity beds-with the majority being the superficial femoral artery (SFA) (70%). Interestingly, though the SFA is the mostly common site for the use of this device-the articles highlight its application in the iliac, common femoral, and below the knee locations. It should also be noted that based on the essential prescribing information provided by Cordis [3], the stated indication is that the catheter is "intended to facilitate placement and positioning of guidewires and catheters within the peripheral vasculature"-however, as the authors mention the FDA approval for use is in calcified femoropopliteal segments only. The authors demonstrate that other anatomic locations outside the femoropopliteal bed are certainly approachable-but should be attempted with caution.Specifically, several caveats should be considered when looking at these data. Obviously as a small retrospective series, we should be cautious of selection bias. It remains unclear whether certain patients, lesions, or anatomic locations would be better suited for one device versus another-particularly as no randomized evaluation has been performed. In the case of iliac re-entry particularly when the distal abdominal aorta is involved-puncture outside the vessel may increase the risk of major bleeding. The authors suggest that it may be better for experienced operators to attempt the use of the Outback in these situations. Not directly mentioned, but worth noting is the importance of having adequate bailout equipment available including covered stents and large diameter aortic occlusion balloons [e.g., Coda ball...

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True lumen re-entry after extravascular recanalization of a superficial femoral artery chronic total occlusion

Cited by 4 publications

References 5 publications

Limitations of the Outback LTD re-entry device in femoropopliteal chronic total occlusions

Limitations of the Outback LTD re-entry device in femoropopliteal chronic total occlusions

Extravascular Revascularization of a Chronic Total Occlusion Using the Dual Bull’s-Eye Technique

Finding your way back: Wires, loops, needles and balloons

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