Transpedal approach for femoral-popliteal chronic total occlusions using the outback® elite re-entry device

Abstract

Background Transpedal access is increasingly utilized for the treatment of peripheral artery disease (PAD). Femoral-popliteal artery chronic total occlusions (CTOs) are some of the most difficult lesion subsets that sometimes require the use of re-entry support devices during percutaneous intervention. Limited data is available on the use of re-entry devices when treating femoral-popliteal CTOs via transpedal access. The aim of this study was to demonstrate the feasibility of using the Outback® Elite re-entry device for the treatment of femoral-popliteal CTOs via the transpedal approach in an outpatient based lab setting. Methods Seventeen patients presented with femoral-popliteal CTOs in which treatment required the use of the Outback® Elite re-entry device. All procedures were performed in a single outpatient based lab. Patients were followed at 1 week and 1 month post-procedure, with lower extremity arterial duplex ultrasound assessment during the 1 month follow-up. Results The average patient age was 78 years-old, with 71% being males. Most patients presented with Rutherford class IV symptoms. Procedural success was achieved in all patients with no requirement to convert to femoral artery access in any of the cases. No immediate post-procedural complications nor at any time during follow-up were observed. Ultrasonography at 1 month follow-up showed patent intervention sites and access site vessels in all patients. Conclusion The use of the Outback® Elite re-entry device for the treatment of femoral-popliteal CTOs via transpedal access is a feasible option and may have potential benefits by avoiding risks associated with traditional femoral artery access.

The Use of Re-Entry Devices Through Pedal Arterial Access in the Management of Chronic Limb-Threatening Ischemia

“…9 As far as the access used for these re-entry catheters, the contralateral CFA has been the most widely described. 10 The ipsilateral antegrade CFA approach can be used, although its use is limited in cases of very small or very proximal SFA stumps, which limits guidewire and catheter manipulation. The trans-popliteal, trans-tibial, and trans-peroneal approaches have also been described.…”

“…The trans-popliteal, trans-tibial, and trans-peroneal approaches have also been described. [10][11][12] Gorenchtein et al described 17 patients who underwent revascularization of femoral-popliteal CTO lesions via trans-tibial and trans-peroneal approaches. 10 In their series, all patients were successfully revascularized in an outpatient setting, with evidence of revascularization via ultrasound studies 1 month postintervention, without any access site complications.…”

“…[10][11][12] Gorenchtein et al described 17 patients who underwent revascularization of femoral-popliteal CTO lesions via trans-tibial and trans-peroneal approaches. 10 In their series, all patients were successfully revascularized in an outpatient setting, with evidence of revascularization via ultrasound studies 1 month postintervention, without any access site complications. There is a single report of retrograde tibial access utilizing the Pioneer Plus catheter 13 but none so far to our knowledge, detailing a true pedal, DPA access, such as the 2 cases herein presented.…”

Percutaneous Intentional Extraluminal Recanalization of Chronic Total Occlusions: A Review of Reentry Devices

“…Studies have demonstrated efficacious use of Outback catheter for reentry from retrograde femoropopliteal, crural, or pedal access to the femoral, popliteal, or below-the-knee arteries. 24,39,40 The largest of these showed a 91% success rate of recanalization in 45 patients with an 11% complication rate including two distal emboli and three bleeding episodes. 24 The authors noted an increasing preference for the sheathless use of the 5.9-Fr Outback catheter, which is a lower profile than the 8-Fr outer diameter of the required sheath.…”