Abstract
BackgroundRe-entry devices are used regularly in subintimal recanalization of chronic occlusions of the iliac and femoro-popliteal arteries and significantly contribute to the high success rate of these interventions. However, the use in tibio-peroneal arteries has only been described in few cases so far. The present work is a retrospective evaluation of the Outback® re-entry device for gaining targeted true lumen access at the level of the tibio-peroneal arteries.MethodsFrom 9/2017 until 10/2020 the Outback® catheter was used in case of failed spontaneous re-entry at the level of the tibio-peroneal arteries in 14 patients either instead of the usual retrograde approach via a pedal/distal-crural access (n = 11) or in combination with it (n = 3). Baseline demographic and clinical data, morphologic characteristics of the occlusions, procedural succedss, as well as the Society of Vascular Surgery (SVS) runoff score before and after revascularization were documented.ResultsAll patients (median age: 78 years; range: 66–93) suffered from peripheral artery occlusive disease Rutherford stage 4 to 6 with a median lesion length of 12 cm (range: 7–35). Technical and procedural success was achieved in all 14 patients. The mean re-entry accuracy was 0.25 cm (range: 0–0.8). The SVS runoff score improved from a median of 14.5 (interquartile range IQR: 10.8–16.4) to 7 (IQR: 6.3–7) (p < 0.01).ConclusionsThe use of the Outback® catheter for targeted tibio-peroneal re-entry is associated with a high technical and procedural success rate and should be considered in case of otherwise failed ante- and retrograde recanalization.
Highlights
As a result of demographic change and increasing life expectancy, the number of mainly older patients with clinically relevant peripheral arterial occlusive disease is increasing (Kreutzburg et al 2020)
The aim of the present retrospective analysis is the technical evaluation of the Cordis Outback re-entry catheter (Cordis - a Cardinal Health Company, Santa Clara, CA, USA) for a targeted re-entry in cases where neither antegrade nor retrograde recanalization was reasonably possible
Study design and patient population In this retrospective study all consecutive patients, who were treated within the 38 months period from September 2017 until October 2020 for chronic total occlusions (CTO) by using the Outback® catheter for targeted tibio-peroneal re-entry in subintimal recanalization, were included
Summary
As a result of demographic change and increasing life expectancy, the number of mainly older patients with clinically relevant peripheral arterial occlusive disease is increasing (Kreutzburg et al 2020). The aim of the present retrospective analysis is the technical evaluation of the Cordis Outback re-entry catheter (Cordis - a Cardinal Health Company, Santa Clara, CA, USA) for a targeted re-entry in cases where neither antegrade nor retrograde recanalization was reasonably possible. The Outback catheter is by far the best studied re-entry device available, only about 10 cases of its use in tibio-peroneal arteries were published so far (Diamantopoulos et al 2018; Aslam et al 2013; Patrone et al 2019; Tai and Lee 2015). Re-entry devices are used regularly in subintimal recanalization of chronic occlusions of the iliac and femoro-popliteal arteries and significantly contribute to the high success rate of these interventions. The present work is a retrospective evaluation of the Outback® re-entry device for gaining targeted true lumen access at the level of the tibio-peroneal arteries
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