9:20 AM Abstract No. 22 - Subintimal recanalization of difficult iliac and femoral artery chronic total occlusions using a reentry device: a single-center experience

Abstract

Purpose To present our experience with the technical outcome of the endovascular recanalization of occluded iliac and femoral arteries using Outback LTD reentry catheter when conventional tools and techniques fail to reenter the true arterial lumen. Materials and Methods A retrospective review was performed on 33 consecutive patients (25 men; mean age +/- SD, 75 years +/- 12) who underwent endovascular treatment for iliac and femoral arterial occlusions during a period of 67 months, from December 2006 to July 2012, at a single tertiary-care medical center. The Outback LTD reentry catheter was used to regain access into the true arterial lumen over a 0.014-in wire from the subintimal space following unsuccessful attempts with conventional guidewires. Immediate and late adverse effects (mean length of follow-up 12 months) were assessed. Results Procedure outcome was improved by achieving true lumen reentry in 79% (n = 26) of patients with iliac and femoral occlusions. Causes of failure included inability to re-enter the true lumen (n=5), acute angle of aortic bifurcation (n=1), and difficulty tracking the device through the lesion (n=1). Encountered acute procedure-related complications included acute thrombosis of the CFA and SFA (n=1), iliac artery perforation (n=2), and distal embolization (n=1). These complications were corrected immediately with endovascular techniques (n=3) or open surgical embolectomy (n=1), without any procedure-related late adverse effects. Conclusion This study shows that use of reentry catheters significantly improves the outcome of endovascular treatments in patients who otherwise would have required surgical intervention with its associated higher morbidity, cost, and hospital stay with no long term adverse effects. The incidence of iliac complications is concerning, however the majority of complications could be managed with endovascular techniques. In conclusion, the Outback LTD reentry catheter is an effective endovascular tool, the use of which enhances the likelihood of successful subintimal recanalization of chronic occlusions in iliac and femoral arteries.