Native chronic total occlusion recanalization after lower limb bypass graft occlusion: A series of nine cases

• Published in: Catheterization and cardiovascular interventions Vol. 76; no. 2; pp. 214 - 219
• Main Authors: Kawarada, Osami, Yokoi, Yoshiaki
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.08.2010
• Subjects: Aged; Angioplasty - instrumentation; Ankle Brachial Index; Blood Vessel Prosthesis Implantation - adverse effects; bypass occlusion; chronic total occlusion; Female; Graft Occlusion, Vascular - diagnosis; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - physiopathology; Graft Occlusion, Vascular - therapy; Humans; Ischemia - diagnosis; Ischemia - etiology; Ischemia - physiopathology; Ischemia - therapy; Japan; Limb Salvage; Lower Extremity - blood supply; Male; Middle Aged; native; Peripheral Vascular Diseases - surgery; Recovery of Function; Regional Blood Flow; Retrospective Studies; Stents; Time Factors; Treatment Outcome; Wound Healing; Japan
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.22445

Objective: The aim of the study was to report the clinical utility of native chronic total occlusion (CTO) recanalization as an endovascular strategy in lower limb bypass graft occlusion. Background: There is no consensus on the best approach for threatened limbs in patients with graft occlusion. Methods: The subjects were nine consecutive patients with limb‐threatening ischemia after bypass graft occlusion. Native CTO recanalization was attempted endovascularly using conventional intraluminal and subintimal angioplasty techniques supported by stents. Results: The mean age of the bypass grafts was 6.7 ± 7.3 (range: 1–24) months and the mean number of previous lower limb bypass surgeries was 1.4 ± 0.5 (range: 1–2). Native CTO recanalization was performed in the iliofemoral (n = 2), iliac (n = 2), superficial femoral (n = 3), popliteal (n = 1), and popliteal‐tibial (n = 1) arteries. Technical success was achieved in 89% (8/9) of cases without complications or major adverse cardiovascular events. The ankle‐brachial index and skin perfusion pressure of the foot significantly increased after revascularization, with marked improvement of clinical symptoms (Rutherford class: 4.5 ± 1.1→0.9 ± 1.4, P < 0.001). Limb salvage was achieved in all successful recanalization cases during the mean follow‐up time of 25 ± 20 months (range: 9–60). Conclusions: In this preliminary study, endovascular recanalization of native CTO showed satisfactory outcomes in patients with bypass graft occlusion. © 2010 Wiley‐Liss, Inc.