Use, Safety and Effectiveness of Subintimal Angioplasty and Re-Entry Devices for the Treatment of Iliac Artery Chronic Total Occlusions: A Systematic Review of 30 Studies and 1112 Lesions

The Use of Re-entry Devices in Aortoiliac Occlusive Disease

“…Traditional PIER, performed with a hydrophilic guidewire and a support catheter, can cross the lesion by dissecting the subintimal space, passing through the occluded area and crossing back distally in the TL ( 14 ). However, it fails in revascularizing long or highly calcified iliac CTOs in about 20–25% of cases ( 2 , 16 ), because of failure to re-enter the TL ( 17 – 20 ) or because the dissection occludes vessels that should be spared to keep patency of the collateral network ( 6 , 18 , 21 , 22 ).…”

“…Considering the stiffness of the system, the preferred approach is the retrograde homolateral one even though anterograde contralateral approach has been described ( 2 ) but, as already said, tortuous bifurcations can misalign inner lumen and markers of the catheter, with subsequent unsuccessful performance ( 11 ).…”

“…Recently, Kokkinidis et al ( 2 ) published a systematic review of the literature, concerning 1002 patients (and 1112 lesions) who benefit from a PIER of the AT with or without RED. Specifically, 22% of lesions were treated with RED and, out of the eight studies providing the information, RED was used as a first option (without previously attempting traditional PIER) in 50% of papers.…”

“…The tracking system and the high penetration capability of the catheter allows precise iliac or aortic recanalization, reducing the risk for multiple extravascular punctures in the retroperitoneal space ( 2 ).…”

“…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.…”