Chronic total occlusions in peripheral vasculature: techniques and devices

Abstract

Peripheral artery disease continues to increase in an ever-aging society and consumes a significant part of health resources. Chronic total occlusions account for a significant portion of the lesions encountered by endovascular interventionalists. Unlike the coronary circulation, these occlusions are often long and associated with other features of complexity. The two primary issues concerning these lesions are the ability to safely achieve intimal angiographic success and the long-term durability of therapy. Traditionally, the use of percutaneous techniques was limited to certain anatomic subsets, such as stenosis or total occlusions. However, recent advances in wire technology, re-entry catheters, alternative crossing tools and atherectomy devices have increased the interventional armamentarium for this challenging disease subset. This article will focus on some of the techniques in crossing chronic total occlusions lesions, as well as the available devices to improve long-term patency.

Avanços nos materiais e no tratamento endovascular de oclusões arteriais crônicas totais: um relato de caso

“…Trata-se de um cateter com proposta inovadora para transposição de placas calcificadas com taxa de sucesso na ordem de 63 a 76% 8,9 em transpor lesões onde o fio-guia não possibilitou a transposição das mesmas. Este cateter possui em sua extremidade distal, um mecanismo articulado que permite a abertura de um pertuito através da placa (Figura 11) 10 . Desta forma possibilita a passagem de um microcateter, dentro do qual navegará um fio-guia 0.014", possibilitando a realização da angioplastia.…”

“…Uma adversidade descrita e observada no caso acima relatado foi a saída subintimal do Frontrunner ® após a transposição da placa. Assim sendo, novamente a utilização de um material como recurso técnico para situações específicas como essa possibilitou a realização do procedimento, pois a reentrada do guia na luz da artéria pós-lesão só foi possível com a utilização do cateter de reentrada (Outback ® ) (Figura 12) 10 , onde um mecanismo de agulha retrátil e direcionável por radioscopia permitiu o retorno do fio-guia para a luz verdadeira. A taxa de sucesso de procedimentos, nos quais foi necessário o uso deste material, gira em torno de 95% segundo a literatura 11 .…”

Endovascular Sharp Recanalization for Calcified Femoropopliteal Artery Occlusion

“…Various techniques and devices have been developed to facilitate the introduction and placement of the guidewire into distal blood vessels. However, these devices are quite expensive and may not be readily available for use in routine clinical practice [4–9]. Very few reports have been published on the management of peripheral CTOs by using the sharp recanalization technique in which the stiff end of the glidewire is advanced into the artery.…”

Initial Experience With the 5×300-mm Proteus Embolic Capture Angioplasty Balloon in the Treatment of Peripheral Vascular Disease

“…[1][2][3][4][5][6] As the techniques improve, more patients with complex lesions, multiple comorbidities, and See commentary page 834 severe forms of peripheral artery disease (PAD) are being considered for this kind of minimally invasive intervention.…”

“…The number of lower limb interventions is growing every year worldwide, paced by the development of novel devices and techniques to improve procedure success. 1–6 As the techniques improve, more patients with complex lesions, multiple comorbidities, and severe forms of peripheral artery disease (PAD) are being considered for this kind of minimally invasive intervention.…”