Abstract No. 147 Retrograde recanalization of infrainguinal chronic total occlusions in an outpatient-based lab setting

Abstract

Retrograde recanalization of chronic total occlusions (CTO) has become an essential technique when treating patients with critical limb ischemia. However, this technique has often been labeled a high-risk skill limiting utilization in the outpatient-based lab (OBL) setting. Here, we investigate the safety and efficacy of retrograde recanalization in treating Infrainguinal CTOs in the OBL setting. A retrospective chart review identified 53 patients over a 2-year period with Rutherford 3 (7.5%), 4 (7.5%), 5 (52.8%), 6 (32.1%) disease, who had undergone retrograde recanalization of infrainguinal CTOs after traditional techniques had failed. Mean age was 70.7 years and 75% were male. The majority of patients suffered from multifocal and/or long segment occlusions with 81% involving the infrageniculate arteries. Overall technical success was 100% and all patients were discharged home the same day. There were no major complications and only 2 minor complications (1 femoral pseudoaneurysm treated with a stent graft and 1 minimally flow limiting dissection not requiring treatment). No patients in the cohort subsequently underwent a distal bypass. No patients required subsequent major amputation and 9 patients required minor amputation (9 ray). Of those presenting with wounds, 85% of patients showed evidence of wound healing or had completely healed their wound at 3 months, while 46% had completely healed their wounds at 6 months. Retrograde recanalization of infrainguinal chronic total occlusions is a safe and effective treatment strategy that can be performed in an OBL setting. It has a high technical success rate and a low risk profile and should be considered in those patients who have failed traditional antegrade techniques and are not candidates for a below-the-knee arterial bypass.