Chronic Total Occlusion Angioplasty: Indications, Appropriateness, and Strategy

2013 ◽  
pp. 289-297
Author(s):  
J. Aaron Grantham ◽  
Craig A. Thompson
Keyword(s):  
Chronic Total Occlusion ◽  
Total Occlusion

Primary Stenting for Chronic Total Occlusion of the Infrarenal Aorta

2000 ◽  
Vol 7 (4) ◽  
pp. 340-344 ◽  
Author(s):  
Christos D. Karkos ◽  
Stephen P. D'Souza ◽  
Robert Hughes
Keyword(s):  
Chronic Total Occlusion ◽  
Infrarenal Aorta ◽  
Total Occlusion ◽  
Primary Stenting

scholarly journals Successful case of direct puncture of a prosthetic bypass graft in endovascular treatment for long superficial artery chronic total occlusion: a case report

2020 ◽  
Author(s):  
Makoto Sugihara ◽  
Yoko Ueda ◽  
Yuiko Yano ◽  
Shin-Ichiro Miura
Keyword(s):  
Femoral Artery ◽  
Chronic Total Occlusion ◽  
Bypass Graft ◽  
Common Femoral Artery ◽  
Critical Limb Ischaemia ◽  
Complete Revascularization ◽  
Anastomotic Site ◽  
Graft Occlusion ◽  
Total Occlusion ◽  
Direct Puncture

Abstract Background The access site for endovascular therapy (EVT) is often limited because of multi-vascular diseases. Prior lower limb bypass can potentially limit the availability of common femoral artery access when EVT is required. Case summary An 88-year-old woman who presented with non-healing ulceration in the dorsalis pedis of the left foot despite treatment for several months was admitted to our hospital. She had undergone axillo-bilateral femoral bypass surgery for right critical limb ischaemia 3 years previously. Ultrasound and contrast computed tomography demonstrated bypass graft occlusion, left superficial femoral artery (SFA)-popliteal artery long chronic total occlusion from the origin with severe calcification and severe stenosis in the bilateral common femoral artery close to the anastomotic site. EVT for the left SFA occlusion was necessary to save the left foot, but access sites for EVT were limited. We decided to puncture an occluded axillo-femoral prosthetic bypass graft. It is difficult to cross the wire with only an antegrade approach. Therefore, it was necessary to use a bi-directional approach with dorsalis pedis artery puncture and the Rendez-vous technique. Finally, angiogram demonstrated improved blood flow to the wound site, and haemostasis at the puncture site could be achieved by manual compression. The ulceration healed within a month. Discussion Direct puncture of a prosthetic bypass graft and additional techniques resulted in complete revascularization. Thus, direct puncture of a bypass graft could be a useful EVT strategy for patients with complex and extremely long chronic total occlusion.

Endothelial avulsion of the septal branch during retrograde chronic total occlusion intervention

2021 ◽  
Author(s):  
Hicham El Jattari ◽  
Carlo Zivelonghi ◽  
Benjamin Scott ◽  
Mick Luykx ◽  
Pierfrancesco Agostoni
Keyword(s):  
Chronic Total Occlusion ◽  
Total Occlusion ◽  
Septal Branch

scholarly journals Late survival benefit of percutaneous coronary intervention compared with medical therapy in patients with coronary chronic total occlusion: a 10-year follow-up study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.K Park ◽  
S.H Choi ◽  
J.M Lee ◽  
J.H Yang ◽  
Y.B Song ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Treatment Strategy ◽  
Initial Treatment ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary

Abstract Background As an initial treatment strategy, percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) did not show mid-term survival benefits compared with optimal medical therapy (OMT). Purpose To compare 10-year clinical outcomes between OMT and PCI in CTO patients. Methods Between March 2003 and February 2012, 2,024 patients with CTO were enrolled in a single center registry and followed for about 10 years. We excluded CTO patients who underwent coronary artery bypass grafting, and classified patients into the OMT group (n=664) or PCI group (n=883) according to initial treatment strategy. Propensity-score matching was performed to minimize potential selection bias. The primary outcome was cardiac death. Results In the PCI group, 699 patients (79.2%) underwent successful revascularization. Clinical and angiographic characteristics revealed more comorbidities and more complex lesions in the OMT group than in the PCI group. At 10 years, the PCI group had lower risks of cardiac death (10.4% versus 22.3%; HR 0.43; 95% CI 0.32 to 0.57; p<0.001) than the OMT group. After the propensity-score matching analyses, the PCI group had lower risks of cardiac death (13.6% versus 20.8%; HR 0.62; 95% CI 0.44 to 0.88; p=0.007), acute myocardial infarction (6.3% versus 11.2%; HR 0.55; 95% CI 0.34 to 0.91; p=0.02), any revascularization (23.9% versus 32.2%; HR 0.67; 95% CI 0.51 to 0.88; p=0.004) than the OMT group. The beneficial effects of CTO PCI were consistent across various subgroups (all p-values for interaction: non-significant). Conclusions As an initial treatment strategy, PCI reduced late cardiac death compared with OMT in CTO patients. Cardiac death in matched population Funding Acknowledgement Type of funding source: None

scholarly journals Treatment of an external iliac artery chronic total occlusion using alternate access sites

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Justin Ratcliffe ◽  
Mike Gorenchtein ◽  
Pankaj Khullar ◽  
Abel Casso Dominguez ◽  
Mohan Satish ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Chronic Total Occlusion ◽  
External Iliac Artery ◽  
Arterial Disease ◽  
Patient Comfort ◽  
Vascular Lesions ◽  
Symptom Improvement ◽  
Total Occlusion ◽  
Maximal Medical Therapy ◽  
Peripheral Arterial

Abstract Background With the advent of endovascular techniques, alternate sites such as the pedal and radial arteries can now be accessed when treating peripheral arterial disease to reduce procedural complications, shorten recovery time, and improve patient comfort. However, a paucity of literature exists on the availability of support devices that can be utilized during challenging cases. Case presentation A 70 year-old female patient presented for evaluation of severe lifestyle-limiting left-sided claudication refractory to maximal medical therapy. Angiography revealed a chronic total occlusion of the left external iliac artery, which was treated successfully by percutaneous intervention via a primary transpedal approach and with the assistance of the Outback® Elite re-entry device. The patient was discharged 2 h after the procedure and reported significant symptom improvement at follow-up. Conclusion This case highlights a newly adopted endovascular approach through an alternate access site and illustrates how the Outback® Elite device can be used as an adjunctive tool in the treatment of complex lower-extremity vascular lesions.

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