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  • Title: Impact of aggressive endovascular recanalization techniques on success rate in chronic total arterial occlusions (CTOs).
    Author: Sharafuddin MJ, Hoballah JJ, Kresowik TF, Nicholson RM, Sharp WJ.
    Journal: Vasc Endovascular Surg; 2010 Aug; 44(6):460-7. PubMed ID: 20484077.
    Abstract:
    PURPOSE: To report experience with aggressive recanalization approaches in chronic total arterial occlusion (CTO). METHODS: Chronic total arterial occlusion recanalization was attempted on 112 limbs in 99 consecutive patients between January 1999 and December 2006. RESULTS: There were 63 iliac arteries, 45 femoropopliteal arteries, and 4 occluded stents. Mean occlusion length was 8.7 ± 4.7 cm. Conventional recanalization was attempted first and was successful in 71 limbs (70%). Probing with the guidewire's stiff end was attempted in 33 of the 41 procedures where conventional techniques failed and was successful in 18 (54%), improving the overall procedural success rate to 80%. For the remaining 15 limbs, home-made directional sharp needle recanalization was attempted in 11 and was successful in 9 (82%), further improving the overall recanalization success to 88%. Procedural complications were self-limited or managed nonoperatively. CONCLUSIONS: Aggressive recanalization techniques in CTO following failure of traditional means are safe and can substantially improve procedural success rates.
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