Native chronic total occlusion recanalization after lower limb bypass graft occlusion: A series of nine cases

Abstract

The aim of the study was to report the clinical utility of native chronic total occlusion (CTO) recanalization as an endovascular strategy in lower limb bypass graft occlusion. There is no consensus on the best approach for threatened limbs in patients with graft occlusion. The subjects were nine consecutive patients with limb-threatening ischemia after bypass graft occlusion. Native CTO recanalization was attempted endovascularly using conventional intraluminal and subintimal angioplasty techniques supported by stents. The mean age of the bypass grafts was 6.7 +/- 7.3 (range: 1-24) months and the mean number of previous lower limb bypass surgeries was 1.4 +/- 0.5 (range: 1-2). Native CTO recanalization was performed in the iliofemoral (n = 2), iliac (n = 2), superficial femoral (n = 3), popliteal (n = 1), and popliteal-tibial (n = 1) arteries. Technical success was achieved in 89% (8/9) of cases without complications or major adverse cardiovascular events. The ankle-brachial index and skin perfusion pressure of the foot significantly increased after revascularization, with marked improvement of clinical symptoms (Rutherford class: 4.5 +/- 1.1-->0.9 +/- 1.4, P < 0.001). Limb salvage was achieved in all successful recanalization cases during the mean follow-up time of 25 +/- 20 months (range: 9-60). In this preliminary study, endovascular recanalization of native CTO showed satisfactory outcomes in patients with bypass graft occlusion.