03:45 PM Abstract No. 18 Arterial recanalization using the Outback LTD re-entry catheter in chronic lower extremity occlusions

Abstract

Revascularization of arterial chronic total occlusions (CTO’s) can result in a subintimal course, requiring true lumen re-entry to establish antegrade flow. Here we report a retrospective study investigating the efficacy of the low profile OUTBACK® LTD re-entry catheter (Cordis, Milpitas CA) in above and below the knee subintimal recanalization of CTO’S when conventional techniques fail. Single-center review of lower extremity revascularizations between March 2013 and July 2018 using the 6 Fr OUTBACK® LTD catheter was conducted. The catheter was used in a total of 58 patients (37 male, mean age 72.3±12.2) with CTO’s. Vascular claudication was the primary indication in 17.2% (10/58) of patients, while critical limb ischemia (CLI) (72.4%, 42/58) accounted for the remainder. 60.3% (35/58) of occlusions were suprapopliteal, while the remaining 39.7% (23/58) were at or below the level of the popliteal artery including the proximal tibial arteries. If conventional recanalization methods were unsuccessful, the catheter was utilized in an antegrade or retrograde fashion to gain re-entry beyond the occlusion in the subintimal space. Technical success rate of re-entry into the true lumen, achievement of arterial patency, and major/minor complication rate were evaluated. The catheter successfully achieved true lumen re-entry beyond the occlusion at a rate of 86.2% (50/58). Final intervention was then performed with balloon angioplasty and/or stenting in 96% (48/50) as deemed appropriate; two failures were due to intraprocedural thrombosis of the recanalized artery. No significant difference was observed when assessing the rate of true lumen re-entry by site of occlusion (29/35 suprapopliteal occlusions vs 21/23 occlusions at or below the level of the popliteal artery, p=0.458). The observed minor complication rate was 10.3% (4 thromboses, 1 postprocedural hematoma, 1 dissection). No major complications were observed. If conventional recanalization methods are unsuccessful, the OUTBACK® LTD catheter is safe and effective in achieving luminal re-entry for subsequent recanalization in lower extremity arterial chronic total occlusions, independent of occlusion site.