Endovascular Management as First Therapy for Chronic Total Occlusion of the Lower Extremity Arteries:Comparison of Balloon Angioplasty, Stenting, and Directional Atherectomy

2011 ◽  
Vol 18 (5) ◽  
pp. 624-637 ◽  
Author(s):  
Katherine A. Gallagher ◽  
Andrew J. Meltzer ◽  
Reid A. Ravin ◽  
Ashley Graham ◽  
Gautam Shrikhande ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Balloon Angioplasty ◽  
Chronic Total Occlusion ◽  
Endovascular Management ◽  
Total Occlusion ◽  
Directional Atherectomy

scholarly journals Endovascular Management As First Therapy for Chronic Total Occlusion (CTO) of the Lower Extremity Arteries: 2-Year Results

2010 ◽  
Vol 52 (4) ◽  
pp. 1119-1120
Author(s):  
Katherine Gallagher ◽  
Ashley Graham ◽  
Sikandar Z. Khan ◽  
Muhammad A. Khan ◽  
Harry Bush ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Chronic Total Occlusion ◽  
Endovascular Management ◽  
Total Occlusion

Ocelot catheter for the recanalization of lower extremity arterial chronic total occlusion

2014 ◽  
Vol 15 (1) ◽  
pp. 46-49 ◽  
Author(s):  
Konstantinos Marmagkiolis ◽  
Vasili Lendel ◽  
Ian Cawich ◽  
Mehmet Cilingiroglu
Keyword(s):  
Lower Extremity ◽  
Chronic Total Occlusion ◽  
Total Occlusion

Comparison of drug-coated balloon angioplasty versus uncoated balloon angioplasty in treatment of total occlusions with severe femoropopliteal lesions: An additional analysis from the AcoArt I study

Vascular ◽  
2020 ◽  
pp. 170853812095366
Author(s):  
Guoyi Sun ◽  
Jie Liu ◽  
Senhao Jia ◽  
Jiwei Zhang ◽  
Baixi Zhuang ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Chronic Total Occlusion ◽  
Ankle Brachial Index ◽  
Target Lesion ◽  
Primary Patency ◽  
Target Lesion Revascularization ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Late Lumen Loss ◽  
Drug Coated Balloon

Objectives Femoropopliteal chronic total occlusions are challenging to treat, and evidence of the effectiveness of drug-coated balloon angioplasty for long femoropopliteal chronic total occlusion lesions is limited. We compared the midterm outcomes of drug-coated balloon angioplasty versus plain old balloon angioplasty (POBA) for femoropopliteal chronic total occlusions. Methods In total, 95 patients from the AcoArt I trial (ClinicalTrials.gov identifier NCT01850056) with ≥5-cm femoropopliteal chronic total occlusion lesions were enrolled in this post-hoc subset analysis (drug-coated balloon, n = 50; POBA, n = 45). The primary endpoints were primary patency and clinically driven target lesion revascularization (CD-TLR) at 24 months. The secondary endpoints were late lumen loss at six months and binary restenosis, major adverse events (composite of death and target limb amputation), change in the Rutherford class, and the ankle-brachial index at 24 months. Results Demographic, clinical, and lesion characteristics were matched (mean lesion length, 20 cm). The six-month late-lumen loss rate was lower in the drug-coated balloon than POBA group (0.18 ± 0.81 vs. 1.34 ± 0.94 mm, respectively; P < 0.001). The 24-month primary patency rate was significantly higher in the drug-coated balloon than POBA group (53.85% vs. 17.50%, respectively; P < 0.001). The CD-TLR rate in the drug-coated balloon and POBA groups was 12.77 and 45.24%, respectively ( P = 0.002). The 24-month overall mortality rate in the drug-coated balloon and POBA groups was 12.77% and 6.98%, respectively ( P = 0.360), with no device- or procedure-related deaths. One major amputation had occurred in each group by the 24-month follow-up. Conclusion The paclitaxel drug-coated balloon shows better primary patency and freedom from target lesion revascularization than POBA at 24 months after treatment of femoropopliteal chronic total occlusions (≥5 cm) lesion.

Impact of Prolonged Inflation Times During Plain Balloon Angioplasty on Angiographic Dissection in Femoropopliteal Lesions

2018 ◽  
Vol 25 (6) ◽  
pp. 683-691 ◽  
Author(s):  
Kazunori Horie ◽  
Akiko Tanaka ◽  
Masataka Taguri ◽  
Shigeaki Kato ◽  
Naoto Inoue
Keyword(s):  
Balloon Angioplasty ◽  
Chronic Total Occlusion ◽  
De Novo ◽  
Balloon Dilation ◽  
Primary Patency ◽  
Balloon Inflation ◽  
Total Occlusion ◽  
Kaplan Meier ◽  
Initial Strategy ◽  
Type C

Purpose: To investigate if balloon angioplasty with a prolonged inflation time (>3 minutes) can prevent postdilation dissection in femoropopliteal lesions. Methods: A retrospective single-center analysis examined 294 consecutive patients (mean age 74.1±8.7 years; 215 men) with de novo femoropopliteal lesions treated with balloon angioplasty between 2013 and 2018. The patients were classified into 2 groups to compare angiographic dissection patterns: 175 patients treated with balloon angioplasty for 3 minutes (3-minute group) and 119 treated for >3 minutes (>3-minute group). Results: Mean balloon inflation time was 7.8±2.7 minutes in the >3-minute group. Severe dissections (type C or higher) were observed less frequently after balloon dilation in the >3-minute group (22.7% vs 50.9%, p<0.001); therefore, significantly more patients in the >3-minute group had successful endovascular treatment after initial balloon angioplasty (57.1% vs 38.3%, p=0.001). Additional balloon dilation was attempted more frequently in the 3-minute group (30.9% vs 14.3%, p=0.001); as a result, there were more patients in whom additional balloon dilation repaired severe dissection that occurred after the initial dilation (25.1% vs 10.9%, p=0.001). Multivariate analysis revealed that chronic total occlusion (p<0.001) and longer lesion (p<0.001) were independent predictors of severe dissection, and prolonged dilation time was independently related to preventing severe dissection (p<0.001). Among 171 patients undergoing successful balloon angioplasty without stent implantation, the Kaplan-Meier estimates of primary patency within 1 year did not differ significantly according to inflation time. Conclusion: Balloon dilation with prolonged inflation time (>3 minutes) may be effective as an initial strategy to prevent severe dissection in femoropopliteal lesions compared to inflation for 3 minutes.

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