Transvenous Intravascular Ultrasound–Guided Endovascular Treatment for Chronic Total Occlusion of the Infrainguinal Arteries

Abstract

Purpose: To investigate the 1-year outcomes of transvenous intravascular ultrasound (IVUS)–guided endovascular therapy (EVT) for chronic total occlusion (CTO) of the lower extremity arteries. Methods: Transvenous IVUS-guided EVT was performed in 44 patients (50 limbs) with CTO of the femoropopliteal arteries or tibioperoneal trunk. Treatment involved crossing a guidewire through the CTO under the guidance of both fluoroscopic and IVUS imaging, along with insertion of the IVUS catheter into a vein parallel to the target artery. Primary success rate, complications, and target lesion revascularization (TLR) at 12-month follow-up were investigated. Results: Successful recanalization, defined as grade 3 flow (Thrombolysis in Myocardial Infarction score) and no flow-limiting dissection, was observed in 48 (96%) limbs. Two limbs with failed recanalization had a very long CTO lesion from the superficial femoral artery to below the knee. A bidirectional approach was selected in 11 (22%) limbs. Complications at the access site occurred in only 2 patients. The rate of freedom from TLR at 12 months was 77.9% (95% confidence interval 61.4 to 87.9). Conclusion: Transvenous IVUS-guided EVT is safe and can provide optimal short-term results for EVT of CTO in the infrainguinal arteries. IVUS-guided EVT may be one of the most effective treatment strategies for CTO of the femoropopliteal arteries or tibioperoneal trunk.

Keywords

balloon angioplasty chronic total occlusion endovascular treatment femoral vein femoropopliteal segment guidewire infrainguinal arteries intravascular ultrasound popliteal artery recanalization stent superficial femoral artery tibioperoneal trunk

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References

Norgren

Hiatt

Dormandy

et al . The next 10 years in the management of peripheral artery disease: perspectives from the ‘PAD 2009’ conference. Eur J Vasc Endovasc Surg. 2010;40:375–380.

Ascher

Marks

Schutzer

et al . Duplex-guided balloon angioplasty and stenting for femoropopliteal arterial occlusive disease: an alternative in patients with renal insufficiency. J Vasc Surg. 2005;42:1108–1113.

Ascher

Marks

Hingorani

et al . Duplex-guided endovascular treatment for occlusive and stenotic lesions of the femoral popliteal arterial segment: a comparative study in the first 253 cases. J Vasc Surg. 2006;44:1230–1238.

Kawarada

Yokoi

Morioka

et al . Chronic total occlusions in the SFA: a novel strategy using a 1.5 mm J-tip hydrophilic guidewire with an over-the-wire balloon catheter under ultrasound guidance. Catheter Cardiovasc Interv. 2005;65:187–192.

Noory

Rastan

Schwarzwälder

et al . Retrograde transpopliteal recanalization of chronic SFA occlusion after failed re-entry during antegrade subintimal angioplasty. J Endovasc Ther. 2009;16:619–623.

Pappy

Hennebry

Abu-Fadel

MS.

Retrograde access via the popliteal artery to facilitate the re-entry technique for recalcitrant SFA chronic total occlusions. Catheter Cardiovasc Interv. 2011;78:625–631.

Yvonne

Spiridon

Jacqueline

et al . Outback catheter for femoropopliteal occlusions: immediate and long-term results. J Endovasc Ther. 2011;18:13–21.

Met

Van Lienden

Koelemay

et al . Subintimal angioplasty for peripheral arterial occlusive disease: a systematic review. Cardiovasc Intervent Radiol. 2008;31:687–697.

Buller

Davidson

Virmani

et al . Real-time assessment of experimental arterial angioplasty with transvenous intravascular ultrasound. J Am Coll Cardiol. 1992;19:217–222.

10.

Kriegel

Salles-Cunha

Pigott

et al . Intravenous intravascular ultrasound for arterial visualization: a feasibility study. J Endovasc Surg. 1996;3:429–434.

11.

Beebe

Assadnia

Kriegel

. Biplane color flow duplex intravenous intravascular ultrasound for arterial visualization. J Endovasc Surg. 1998;5:101–105.

12.

Hishikari

Hikita

Sugiyama

et al . Intravenous intravascular ultrasound using the AcuNav ultrasound catheter for guiding recanalization of aortoiliac chronic total occlusions. J Endovasc Ther. 2015;22:269–271.

13.

Takahashi

Okazaki

Mizuno

Transvenous IVUS–guided percutaneous coronary intervention for chronic total occlusion: a novel strategy. J Invasive Cardiol. 2013;25:E143–E146.

14.

Kanda

Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–458.

15.

Norgren

Hiatt

Dormandy

; TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(suppl S):S5–S67.

16.

Flu

Ploeg

Marang-van

Mheen

et al . Patient and procedure-related risk factors for adverse events after infrainguinal bypass. J Vasc Surg. 2010;51:622–627.

17.

Ito

Suzuki

Ito

et al . Novel technique using intravascular ultrasound-guided guidewire cross in coronary intervention for uncrossable chronic total occlusions. Circ J. 2004;68:1088–1092.

18.

Laird

Katzen

Scheinert

et al ; RESILIENT Investigators. Nitinol stent implantation vs. balloon angioplasty for lesions in the superficial femoral and proximal popliteal arteries of patients with claudication: three-year follow-up from the RESILIENT randomized trial. J Endovasc Ther. 2012;19:1–9.

19.

Rastan

Krankenberg

Baumgartner

et al . Stent placement versus balloon angioplasty for the treatment of obstructive lesions of the popliteal artery: a prospective, multicenter, randomized trial. Circulation. 2013;127:2535–2541.