Acute and Midterm Outcomes of Antegrade vs Retrograde Crossing Strategies for Endovascular Treatment of Iliac Artery Chronic Total Occlusions

Damianos G. Kokkinidis, T. Raymond Foley, Ryan Cotter, Prio Hossain, Bejan Alvandi, Omar Jawaid, Moosa N. Haider, Gagan Singh, Stephen W. Waldo, John R. Laird, Ehrin J. Armstrong

Research output: Contribution to journalArticle

Abstract

Purpose: To examine whether an antegrade or retrograde crossing strategy for treatment of iliac artery chronic total occlusions (CTOs) is associated with differences in procedural or midterm outcomes. Materials and Methods: A dual-center retrospective cohort study was conducted in 168 patients (mean age 66.4±10.6 years; 116 men) treated for CTOs in 110 common iliac arteries (CIA), 52 external iliac arteries (EIA), and 26 combined CIA/EIAs. Logistic regression models were developed to determine the association between crossing strategy and procedural complications, 1- and 3-year target lesion revascularization (TLR), and major adverse limb events (MALE). Results are presented as the odds ratio (OR) and 95% confidence interval (CI). Results: An initial antegrade strategy was more common for EIA CTOs (p<0.005), and an initial retrograde strategy was more often used in CIA (p<0.005) and combined CIA/EIA (p<0.005) CTOs. Crossover to an alternate approach was required in 27.6% of initial antegrade attempts and 9.6% of initial retrograde attempts. EIA CTOs were the most likely lesions to be treated successfully with the initial attempt (either strategy). In all, 123 (65.4%) lesions were successfully crossed with a final retrograde approach and 65 with a final antegrade approach. Overall target lesion success was high for both groups (95.1% vs 93.2%, p=0.456). Lesions treated with a final retrograde approach were shorter (75.3±34.9 vs 87.6±31.3 mm, p=0.005) and were more likely to be treated with a reentry device (34.2% vs 9.2%, p<0.001) and with balloon-expandable stents (39.2% vs 17.7%, p=0.005). The final antegrade approach was associated with a lower risk of target lesion complications (OR 0.07, 95% CI 0.01 to 0.81, p=0.034). The two crossing approaches were associated with similar estimates of 1- and 3-year TLR and MALE. Conclusion: A final antegrade approach was associated with lower rates for complications but the 2 approaches were similar in terms of lesion success, TLR, and MALE. The EIA CTOs were more likely to be treated with an antegrade approach and more likely to be crossed successfully with the initial approach irrespective of the crossing direction.

Original languageEnglish (US)
Pages (from-to)342-349
Number of pages8
JournalJournal of Endovascular Therapy
Volume26
Issue number3
DOIs
StatePublished - Jun 1 2019

Fingerprint

Iliac Artery
Therapeutics
Extremities
Logistic Models
Odds Ratio
Confidence Intervals
Stents
Cohort Studies
Retrospective Studies
Equipment and Supplies

Keywords

  • antegrade access
  • chronic total occlusion
  • common iliac artery
  • crossing strategy
  • external iliac artery
  • major adverse limb events
  • peripheral artery disease
  • retrograde access
  • target lesion revascularization

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Acute and Midterm Outcomes of Antegrade vs Retrograde Crossing Strategies for Endovascular Treatment of Iliac Artery Chronic Total Occlusions. / Kokkinidis, Damianos G.; Foley, T. Raymond; Cotter, Ryan; Hossain, Prio; Alvandi, Bejan; Jawaid, Omar; Haider, Moosa N.; Singh, Gagan; Waldo, Stephen W.; Laird, John R.; Armstrong, Ehrin J.

In: Journal of Endovascular Therapy, Vol. 26, No. 3, 01.06.2019, p. 342-349.

Research output: Contribution to journalArticle

Kokkinidis, DG, Foley, TR, Cotter, R, Hossain, P, Alvandi, B, Jawaid, O, Haider, MN, Singh, G, Waldo, SW, Laird, JR & Armstrong, EJ 2019, 'Acute and Midterm Outcomes of Antegrade vs Retrograde Crossing Strategies for Endovascular Treatment of Iliac Artery Chronic Total Occlusions', Journal of Endovascular Therapy, vol. 26, no. 3, pp. 342-349. https://doi.org/10.1177/1526602819845679
Kokkinidis, Damianos G. ; Foley, T. Raymond ; Cotter, Ryan ; Hossain, Prio ; Alvandi, Bejan ; Jawaid, Omar ; Haider, Moosa N. ; Singh, Gagan ; Waldo, Stephen W. ; Laird, John R. ; Armstrong, Ehrin J. / Acute and Midterm Outcomes of Antegrade vs Retrograde Crossing Strategies for Endovascular Treatment of Iliac Artery Chronic Total Occlusions. In: Journal of Endovascular Therapy. 2019 ; Vol. 26, No. 3. pp. 342-349.
@article{7eb9674ab0924de495b81ecca7ed6dfe,
title = "Acute and Midterm Outcomes of Antegrade vs Retrograde Crossing Strategies for Endovascular Treatment of Iliac Artery Chronic Total Occlusions",
abstract = "Purpose: To examine whether an antegrade or retrograde crossing strategy for treatment of iliac artery chronic total occlusions (CTOs) is associated with differences in procedural or midterm outcomes. Materials and Methods: A dual-center retrospective cohort study was conducted in 168 patients (mean age 66.4±10.6 years; 116 men) treated for CTOs in 110 common iliac arteries (CIA), 52 external iliac arteries (EIA), and 26 combined CIA/EIAs. Logistic regression models were developed to determine the association between crossing strategy and procedural complications, 1- and 3-year target lesion revascularization (TLR), and major adverse limb events (MALE). Results are presented as the odds ratio (OR) and 95{\%} confidence interval (CI). Results: An initial antegrade strategy was more common for EIA CTOs (p<0.005), and an initial retrograde strategy was more often used in CIA (p<0.005) and combined CIA/EIA (p<0.005) CTOs. Crossover to an alternate approach was required in 27.6{\%} of initial antegrade attempts and 9.6{\%} of initial retrograde attempts. EIA CTOs were the most likely lesions to be treated successfully with the initial attempt (either strategy). In all, 123 (65.4{\%}) lesions were successfully crossed with a final retrograde approach and 65 with a final antegrade approach. Overall target lesion success was high for both groups (95.1{\%} vs 93.2{\%}, p=0.456). Lesions treated with a final retrograde approach were shorter (75.3±34.9 vs 87.6±31.3 mm, p=0.005) and were more likely to be treated with a reentry device (34.2{\%} vs 9.2{\%}, p<0.001) and with balloon-expandable stents (39.2{\%} vs 17.7{\%}, p=0.005). The final antegrade approach was associated with a lower risk of target lesion complications (OR 0.07, 95{\%} CI 0.01 to 0.81, p=0.034). The two crossing approaches were associated with similar estimates of 1- and 3-year TLR and MALE. Conclusion: A final antegrade approach was associated with lower rates for complications but the 2 approaches were similar in terms of lesion success, TLR, and MALE. The EIA CTOs were more likely to be treated with an antegrade approach and more likely to be crossed successfully with the initial approach irrespective of the crossing direction.",
keywords = "antegrade access, chronic total occlusion, common iliac artery, crossing strategy, external iliac artery, major adverse limb events, peripheral artery disease, retrograde access, target lesion revascularization",
author = "Kokkinidis, {Damianos G.} and Foley, {T. Raymond} and Ryan Cotter and Prio Hossain and Bejan Alvandi and Omar Jawaid and Haider, {Moosa N.} and Gagan Singh and Waldo, {Stephen W.} and Laird, {John R.} and Armstrong, {Ehrin J.}",
year = "2019",
month = "6",
day = "1",
doi = "10.1177/1526602819845679",
language = "English (US)",
volume = "26",
pages = "342--349",
journal = "Journal of Endovascular Therapy",
issn = "1526-6028",
publisher = "International Society of Endovascular Specialists",
number = "3",

}

TY - JOUR

T1 - Acute and Midterm Outcomes of Antegrade vs Retrograde Crossing Strategies for Endovascular Treatment of Iliac Artery Chronic Total Occlusions

AU - Kokkinidis, Damianos G.

AU - Foley, T. Raymond

AU - Cotter, Ryan

AU - Hossain, Prio

AU - Alvandi, Bejan

AU - Jawaid, Omar

AU - Haider, Moosa N.

AU - Singh, Gagan

AU - Waldo, Stephen W.

AU - Laird, John R.

AU - Armstrong, Ehrin J.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Purpose: To examine whether an antegrade or retrograde crossing strategy for treatment of iliac artery chronic total occlusions (CTOs) is associated with differences in procedural or midterm outcomes. Materials and Methods: A dual-center retrospective cohort study was conducted in 168 patients (mean age 66.4±10.6 years; 116 men) treated for CTOs in 110 common iliac arteries (CIA), 52 external iliac arteries (EIA), and 26 combined CIA/EIAs. Logistic regression models were developed to determine the association between crossing strategy and procedural complications, 1- and 3-year target lesion revascularization (TLR), and major adverse limb events (MALE). Results are presented as the odds ratio (OR) and 95% confidence interval (CI). Results: An initial antegrade strategy was more common for EIA CTOs (p<0.005), and an initial retrograde strategy was more often used in CIA (p<0.005) and combined CIA/EIA (p<0.005) CTOs. Crossover to an alternate approach was required in 27.6% of initial antegrade attempts and 9.6% of initial retrograde attempts. EIA CTOs were the most likely lesions to be treated successfully with the initial attempt (either strategy). In all, 123 (65.4%) lesions were successfully crossed with a final retrograde approach and 65 with a final antegrade approach. Overall target lesion success was high for both groups (95.1% vs 93.2%, p=0.456). Lesions treated with a final retrograde approach were shorter (75.3±34.9 vs 87.6±31.3 mm, p=0.005) and were more likely to be treated with a reentry device (34.2% vs 9.2%, p<0.001) and with balloon-expandable stents (39.2% vs 17.7%, p=0.005). The final antegrade approach was associated with a lower risk of target lesion complications (OR 0.07, 95% CI 0.01 to 0.81, p=0.034). The two crossing approaches were associated with similar estimates of 1- and 3-year TLR and MALE. Conclusion: A final antegrade approach was associated with lower rates for complications but the 2 approaches were similar in terms of lesion success, TLR, and MALE. The EIA CTOs were more likely to be treated with an antegrade approach and more likely to be crossed successfully with the initial approach irrespective of the crossing direction.

AB - Purpose: To examine whether an antegrade or retrograde crossing strategy for treatment of iliac artery chronic total occlusions (CTOs) is associated with differences in procedural or midterm outcomes. Materials and Methods: A dual-center retrospective cohort study was conducted in 168 patients (mean age 66.4±10.6 years; 116 men) treated for CTOs in 110 common iliac arteries (CIA), 52 external iliac arteries (EIA), and 26 combined CIA/EIAs. Logistic regression models were developed to determine the association between crossing strategy and procedural complications, 1- and 3-year target lesion revascularization (TLR), and major adverse limb events (MALE). Results are presented as the odds ratio (OR) and 95% confidence interval (CI). Results: An initial antegrade strategy was more common for EIA CTOs (p<0.005), and an initial retrograde strategy was more often used in CIA (p<0.005) and combined CIA/EIA (p<0.005) CTOs. Crossover to an alternate approach was required in 27.6% of initial antegrade attempts and 9.6% of initial retrograde attempts. EIA CTOs were the most likely lesions to be treated successfully with the initial attempt (either strategy). In all, 123 (65.4%) lesions were successfully crossed with a final retrograde approach and 65 with a final antegrade approach. Overall target lesion success was high for both groups (95.1% vs 93.2%, p=0.456). Lesions treated with a final retrograde approach were shorter (75.3±34.9 vs 87.6±31.3 mm, p=0.005) and were more likely to be treated with a reentry device (34.2% vs 9.2%, p<0.001) and with balloon-expandable stents (39.2% vs 17.7%, p=0.005). The final antegrade approach was associated with a lower risk of target lesion complications (OR 0.07, 95% CI 0.01 to 0.81, p=0.034). The two crossing approaches were associated with similar estimates of 1- and 3-year TLR and MALE. Conclusion: A final antegrade approach was associated with lower rates for complications but the 2 approaches were similar in terms of lesion success, TLR, and MALE. The EIA CTOs were more likely to be treated with an antegrade approach and more likely to be crossed successfully with the initial approach irrespective of the crossing direction.

KW - antegrade access

KW - chronic total occlusion

KW - common iliac artery

KW - crossing strategy

KW - external iliac artery

KW - major adverse limb events

KW - peripheral artery disease

KW - retrograde access

KW - target lesion revascularization

UR - http://www.scopus.com/inward/record.url?scp=85066493583&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066493583&partnerID=8YFLogxK

U2 - 10.1177/1526602819845679

DO - 10.1177/1526602819845679

M3 - Article

VL - 26

SP - 342

EP - 349

JO - Journal of Endovascular Therapy

JF - Journal of Endovascular Therapy

SN - 1526-6028

IS - 3

ER -