Endovascular Recanalization of Chronically Occluded Native Arteries After Failed Bypass Surgery in Patients With Critical Ischemia

Cardiovasc Intervent Radiol. 2015 Dec;38(6):1468-76. doi: 10.1007/s00270-015-1119-y. Epub 2015 May 15.

Abstract

Objective: The study aimed to evaluate the feasibility, safety, and outcome of endovascular recanalization of native chronic total occlusions (CTO) in patients with critical limb ischemia (CLI) and lower extremities bypass graft failure.

Methods: A retrospective review of CLI patients with failed lower limb grafts (>30 days after surgery) that underwent recanalization of native CTO was conducted in two institutions from January 2010 to June 2014. Twenty-eight patients (28 limbs) were included in the study, and all had limited surgical revascularization options. Demographics, procedural data, technical success, complications, vessel patency, limb salvage rates, and survival rates were analyzed.

Results: The mean follow-up period was 12.8 months. The technical success rate was 92.9% (26/28 limbs). The combined ipsilateral antegrade-retrograde approach was performed in nine limbs (32.1%). Major periprocedural (<30 days) complications included two myocardial infarctions (7.1%) and two stent thromboses (7.1%), resulting in one amputation. The ankle brachial index before discharge was significantly improved after recanalization (0.78 ± 0.08 vs. 0.31 ± 0.10, p < 0.01). The primary, assisted primary, and secondary patency rates at 12 months were 52.2, 65.8, and 82.2%, respectively. The limb salvage rate and amputation-free survival rate at 12 months were 91.6 and 87.0%, respectively.

Conclusions: Endovascular recanalization of native CTO in patients with graft failure-related CLI is a feasible, safe, and effective procedure, with reasonable technical success, vessel patency, and limb salvage rates. The technique should be attempted before amputation in patients with limited surgical revascularization options.

Keywords: Chronic total occlusions; Critical limb ischemia; Endovascular therapy; Graft failure.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiography, Digital Subtraction
  • Chronic Disease
  • Endovascular Procedures / methods*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Graft Occlusion, Vascular / diagnostic imaging
  • Graft Occlusion, Vascular / surgery*
  • Humans
  • Ischemia / diagnostic imaging
  • Ischemia / surgery*
  • Lower Extremity / blood supply
  • Lower Extremity / diagnostic imaging
  • Male
  • Middle Aged
  • Radiography, Interventional
  • Retrospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ultrasonography, Doppler