Outcome and Distal Access Patency in Subintimal Arterial Flossing with Antegrade-Retrograde Intervention for Chronic Total Occlusions in Lower Extremity Critical Limb Ischemia |
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Affiliation: | 1. Department of Cardio-Vascular Surgery, Air Force Medical Center of People''s Liberation Army, Beijing, 100142, China;2. Department of Vascular Surgery, Peking University People''s Hospital, Beijing, People''s Republic of China;1. Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States;2. Division of Cardiology, Denver VA Medical Center, University of Colorado, Denver, CO, United States;3. Division of Surgery, Medical School, Democritus University of Thrace, Alexandroupoli, Greece;4. Division of Cardiology, Medstar Washington Hospital Center, DC, United States;5. First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece;6. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States;7. Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Cardiovascular Medicine Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States |
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Abstract: | PurposeTo report the outcome and distal access patency of the Subintimal Arterial Flossing with Antegrade-Retrograde Intervention (SAFARI) technique for chronic total occlusion (CTO) in critical limb ischemia (CLI).Materials and MethodsFrom January 2009 to June 2015, 220 SAFARI procedures were performed for 200 limbs in 191 patients (108 males [56.5%]; median age, 70 years old; range, 36 to 97 years old) with CLI (9.4% were Fontaine classification 3; and 90.6% were Fontaine classification 4). Distal access was obtained from the distal superficial femoral artery (n = 6), popliteal artery (n = 49), anterior tibial artery (n = 56), dorsalis pedis (n = 51), peroneal artery (n = 12), posterior tibial artery (n = 45), and lateral plantar artery (n = 1). Distal access hemostasis was obtained with internal balloon tamponade in 71.4% (n = 157). Outcome measurements were technical success, freedom from major amputation and complications. Preprocedural angiograms of clinically driven repeat interventions were reviewed in 73 cases for distal access patency.ResultsTechnical success was achieved in 80.5% (n = 177). Reasons for technical failure include inability to obtain distal access (n = 3), cross the occlusion retrogradely (n = 16), re-enter the true lumen (n = 9), and achieve antegrade blood flow after the procedure (n = 15). Freedom from major amputation for technically successful procedures was 84.7%, 82.9%, and 81.9% at 6, 12, and 24 months, respectively. There were 3 cases of distal access bleeding with 1case that required coil embolization. The distal access remained patent in 80.8% of observable cases with repeated endovascular intervention.ConclusionsDistal retrograde arterial access (SAFARI) technique is safe and effective in the treatment of CTOs in the context of CLI, after failure of antegrade revascularization. |
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Keywords: | CLI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0015" }," $$" :[{" #name" :" text" ," _" :" critical limb ischemia CTO" },{" #name" :" keyword" ," $" :{" id" :" kwrd0025" }," $$" :[{" #name" :" text" ," _" :" chronic total occlusion SAFARI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" Subintimal Arterial Flossing with Antegrade-Retrograde Intervention |
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