Impact of Aggressive Endovascular Recanalization Techniques on Success Rate in Chronic Total Arterial Occlusions (CTOs)

Abstract

To report experience with aggressive recanalization approaches in chronic total arterial occlusion (CTO). Chronic total arterial occlusion recanalization was attempted on 112 limbs in 99 consecutive patients between January 1999 and December 2006. There were 63 iliac arteries, 45 femoropopliteal arteries, and 4 occluded stents. Mean occlusion length was 8.7 ± 4.7 cm. Conventional recanalization was attempted first and was successful in 71 limbs (70%). Probing with the guidewire's stiff end was attempted in 33 of the 41 procedures where conventional techniques failed and was successful in 18 (54%), improving the overall procedural success rate to 80%. For the remaining 15 limbs, home-made directional sharp needle recanalization was attempted in 11 and was successful in 9 (82%), further improving the overall recanalization success to 88%. Procedural complications were self-limited or managed nonoperatively. Aggressive recanalization techniques in CTO following failure of traditional means are safe and can substantially improve procedural success rates.