Technical and early outcomes using ultrasound-guided reentry for chronic total occlusions

Aaron C. Baker, Misty Humphries, Robert E. Noll, Navjeet Salhan, Ehrin J. Armstrong, Timothy K. Williams, W. Darrin Clouse

Research output: Contribution to journalArticle

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Abstract

Background: Subintimal angioplasty is a common treatment for chronic total occlusions (CTOs) in the iliac and infrainguinal arteries. Although technical success has been described using intravascular ultrasound-guided reentry devices (IVUS-RED), outcomes are still not well defined. This report describes the technical aspects and longitudinal follow-up after intravascular ultrasound-guided reentry of iliac and infrainguinal CTOs. Methods: A retrospective review was performed of 20 patients with lower extremity CTO treated with IVUS-RED from 2011 to 2013. A matched cohort of patients who underwent lower extremity interventions without the use of IVUS-RED was also identified. Procedural success, patency estimates, ankle-brachial indices (ABIs), complications, and limb salvage were analyzed. Results: Twenty patients (mean age, 69 ± 13 years), including 11 men and 9 women, underwent attempted IVUS-REDeguided recanalization. Median follow-up was 4.3 months (range, 0.4-24). Eleven patients presented with critical limb ischemia (CLI), and 9 presented with claudication. Technical success was achieved in 18 (90%) patients. Ten common iliac arteries, 3 external iliac arteries, and 5 superficial femoral arteries (SFA) were treated. No intraoperative complications resulted from device use. After procedure, ABIs significantly increased (0.5-0.9; P < 0.01) in the 13 patients with follow-up. Primary patency for the entire cohort was 62% at 12 months. No patient treated for claudication required reintervention, whereas 3 (27%) of those treated for CLI required repeat interventions. During follow-up, 2 patients died unrelated to the procedure, 1 patient required an amputation, and 1 patient eventually required open revascularization. When the IVUS-RED group was compared with a cohort matched on Trans-Atlantic Inter-Society Consensus and age, no difference was found in runoff scores and patency between the 2 groups during follow-up (P > 0.05). Conclusions: Recanalization of CTO using IVUS-RED is safe and effective. Use of IVUS-RED does not adversely impact outcomes in conjunction with other endovascular techniques. Early follow-up demonstrates acceptable patency, especially in patients with claudication, and freedom from reintervention.

Original languageEnglish (US)
Pages (from-to)55-62
Number of pages8
JournalAnnals of Vascular Surgery
Volume29
Issue number1
DOIs
StatePublished - Jan 1 2015

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Equipment and Supplies
Iliac Artery
Ankle Brachial Index
Lower Extremity
Endovascular Procedures
Limb Salvage
Intraoperative Complications
Femoral Artery
Angioplasty
Ischemia
Extremities
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Baker, A. C., Humphries, M., Noll, R. E., Salhan, N., Armstrong, E. J., Williams, T. K., & Clouse, W. D. (2015). Technical and early outcomes using ultrasound-guided reentry for chronic total occlusions. Annals of Vascular Surgery, 29(1), 55-62. https://doi.org/10.1016/j.avsg.2014.10.011

Technical and early outcomes using ultrasound-guided reentry for chronic total occlusions. / Baker, Aaron C.; Humphries, Misty; Noll, Robert E.; Salhan, Navjeet; Armstrong, Ehrin J.; Williams, Timothy K.; Clouse, W. Darrin.

In: Annals of Vascular Surgery, Vol. 29, No. 1, 01.01.2015, p. 55-62.

Research output: Contribution to journalArticle

Baker, Aaron C. ; Humphries, Misty ; Noll, Robert E. ; Salhan, Navjeet ; Armstrong, Ehrin J. ; Williams, Timothy K. ; Clouse, W. Darrin. / Technical and early outcomes using ultrasound-guided reentry for chronic total occlusions. In: Annals of Vascular Surgery. 2015 ; Vol. 29, No. 1. pp. 55-62.
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abstract = "Background: Subintimal angioplasty is a common treatment for chronic total occlusions (CTOs) in the iliac and infrainguinal arteries. Although technical success has been described using intravascular ultrasound-guided reentry devices (IVUS-RED), outcomes are still not well defined. This report describes the technical aspects and longitudinal follow-up after intravascular ultrasound-guided reentry of iliac and infrainguinal CTOs. Methods: A retrospective review was performed of 20 patients with lower extremity CTO treated with IVUS-RED from 2011 to 2013. A matched cohort of patients who underwent lower extremity interventions without the use of IVUS-RED was also identified. Procedural success, patency estimates, ankle-brachial indices (ABIs), complications, and limb salvage were analyzed. Results: Twenty patients (mean age, 69 ± 13 years), including 11 men and 9 women, underwent attempted IVUS-REDeguided recanalization. Median follow-up was 4.3 months (range, 0.4-24). Eleven patients presented with critical limb ischemia (CLI), and 9 presented with claudication. Technical success was achieved in 18 (90{\%}) patients. Ten common iliac arteries, 3 external iliac arteries, and 5 superficial femoral arteries (SFA) were treated. No intraoperative complications resulted from device use. After procedure, ABIs significantly increased (0.5-0.9; P < 0.01) in the 13 patients with follow-up. Primary patency for the entire cohort was 62{\%} at 12 months. No patient treated for claudication required reintervention, whereas 3 (27{\%}) of those treated for CLI required repeat interventions. During follow-up, 2 patients died unrelated to the procedure, 1 patient required an amputation, and 1 patient eventually required open revascularization. When the IVUS-RED group was compared with a cohort matched on Trans-Atlantic Inter-Society Consensus and age, no difference was found in runoff scores and patency between the 2 groups during follow-up (P > 0.05). Conclusions: Recanalization of CTO using IVUS-RED is safe and effective. Use of IVUS-RED does not adversely impact outcomes in conjunction with other endovascular techniques. Early follow-up demonstrates acceptable patency, especially in patients with claudication, and freedom from reintervention.",
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AU - Armstrong, Ehrin J.

AU - Williams, Timothy K.

AU - Clouse, W. Darrin

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N2 - Background: Subintimal angioplasty is a common treatment for chronic total occlusions (CTOs) in the iliac and infrainguinal arteries. Although technical success has been described using intravascular ultrasound-guided reentry devices (IVUS-RED), outcomes are still not well defined. This report describes the technical aspects and longitudinal follow-up after intravascular ultrasound-guided reentry of iliac and infrainguinal CTOs. Methods: A retrospective review was performed of 20 patients with lower extremity CTO treated with IVUS-RED from 2011 to 2013. A matched cohort of patients who underwent lower extremity interventions without the use of IVUS-RED was also identified. Procedural success, patency estimates, ankle-brachial indices (ABIs), complications, and limb salvage were analyzed. Results: Twenty patients (mean age, 69 ± 13 years), including 11 men and 9 women, underwent attempted IVUS-REDeguided recanalization. Median follow-up was 4.3 months (range, 0.4-24). Eleven patients presented with critical limb ischemia (CLI), and 9 presented with claudication. Technical success was achieved in 18 (90%) patients. Ten common iliac arteries, 3 external iliac arteries, and 5 superficial femoral arteries (SFA) were treated. No intraoperative complications resulted from device use. After procedure, ABIs significantly increased (0.5-0.9; P < 0.01) in the 13 patients with follow-up. Primary patency for the entire cohort was 62% at 12 months. No patient treated for claudication required reintervention, whereas 3 (27%) of those treated for CLI required repeat interventions. During follow-up, 2 patients died unrelated to the procedure, 1 patient required an amputation, and 1 patient eventually required open revascularization. When the IVUS-RED group was compared with a cohort matched on Trans-Atlantic Inter-Society Consensus and age, no difference was found in runoff scores and patency between the 2 groups during follow-up (P > 0.05). Conclusions: Recanalization of CTO using IVUS-RED is safe and effective. Use of IVUS-RED does not adversely impact outcomes in conjunction with other endovascular techniques. Early follow-up demonstrates acceptable patency, especially in patients with claudication, and freedom from reintervention.

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