Abstract
BackgroundTranspedal access is increasingly utilized for the treatment of peripheral artery disease (PAD). Femoral-popliteal artery chronic total occlusions (CTOs) are some of the most difficult lesion subsets that sometimes require the use of re-entry support devices during percutaneous intervention. Limited data is available on the use of re-entry devices when treating femoral-popliteal CTOs via transpedal access. The aim of this study was to demonstrate the feasibility of using the Outback® Elite re-entry device for the treatment of femoral-popliteal CTOs via the transpedal approach in an outpatient based lab setting.MethodsSeventeen patients presented with femoral-popliteal CTOs in which treatment required the use of the Outback® Elite re-entry device. All procedures were performed in a single outpatient based lab. Patients were followed at 1 week and 1 month post-procedure, with lower extremity arterial duplex ultrasound assessment during the 1 month follow-up.ResultsThe average patient age was 78 years-old, with 71% being males. Most patients presented with Rutherford class IV symptoms. Procedural success was achieved in all patients with no requirement to convert to femoral artery access in any of the cases. No immediate post-procedural complications nor at any time during follow-up were observed. Ultrasonography at 1 month follow-up showed patent intervention sites and access site vessels in all patients.ConclusionThe use of the Outback® Elite re-entry device for the treatment of femoral-popliteal CTOs via transpedal access is a feasible option and may have potential benefits by avoiding risks associated with traditional femoral artery access.
Highlights
Transpedal access is increasingly utilized for the treatment of peripheral artery disease (PAD)
We show the feasibility of using the Outback® Elite re-entry device for the treatment of femoral-popliteal Chronic total occlusion (CTO) via transpedal access
The pedal area on the ipsilateral side of the affected leg was prepared in sterile fashion and a 21-gauge micropuncture needle was used for arterial access under ultrasound guidance followed by placement of a 4-Fr Glidesheath (Terumo)
Summary
Transpedal access is increasingly utilized for the treatment of peripheral artery disease (PAD). Femoralpopliteal artery chronic total occlusions (CTOs) are some of the most difficult lesion subsets that sometimes require the use of re-entry support devices during percutaneous intervention. Chronic total occlusions (CTOs) in the superficial femoral artery (SFA) or popliteal artery remain one of the hardest lesion subsets to treat and sometimes require re-entry from a dissection plane back into the vessel true lumen. In this case series, we show the feasibility of using the Outback® Elite re-entry device for the treatment of femoral-popliteal CTOs via transpedal access
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