LEA 38. Retrograde Use of the Outback Re-entry Catheter in Complex Infrainguinal Arterial Recanalization

Abstract

The objective of this study was to demonstrate the efficacy and safety of the Outback (Cordis, Santa Clara, Calif) re-entry catheter in complex retrograde subintimal infrainguinal arterial recanalization for patients affected by critical limb ischemia. Between 2015 and 2019, the Outback re-entry catheter was used to re-enter the true lumen in 29 patients with critical limb ischemia who underwent retrograde superficial femoral artery, with or without popliteal artery subintimal recanalization, after failed guidewire and catheter-assisted re-entry. The retrograde access site was distal superficial femoral artery in 21 patients, proximal anterior tibial artery in 5 patients (Fig 1), and proximal peroneal artery in 3 patients. The re-entry target was common femoral artery in 27 patients, proximal superficial femoral artery in 1 patient, and proximal anterior tibial artery in 1 patient. Technical success was 89% (26/29). In all the successful cases, the re-entry was accurate (Fig 2), without damage to the profunda femoral artery. In 25 of 26 successful cases, the lesion was stented after plain balloon angioplasty. Supera (Abbott, Abbott Park, Ill) stent (with the proximal one always deployed from the retrograde access) was the most commonly used stent in 19 cases. The Outback was inserted through a 6F sheath in 13 cases and without any sheath in 16 cases (always when the retrograde access was at the level of below-knee vessels), passing the device over a 0.018-inch guidewire. In all cases, there were no significant complications correlated to the retrograde access. The use of the Outback re-entry catheter after complex retrograde subintimal infrainguinal recanalization has been demonstrated to be effective and safe. The possibility of passing it over a 0.018-inch guidewire gives the chance of doing it without inserting a sheath, reducing the size of the access and possible complications.Fig 2Precise re-entry obtained at the level of the short superficial femoral artery stump and at the anterior tibial origin in two different cases, with wire always eventually passed into the sheath coming from the antegrade access.View Large Image Figure ViewerDownload Hi-res image Download (PPT)