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  • Title: Native chronic total occlusion recanalization after lower limb bypass graft occlusion: a series of nine cases.
    Author: Kawarada O, Yokoi Y.
    Journal: Catheter Cardiovasc Interv; 2010 Aug 01; 76(2):214-9. PubMed ID: 20665865.
    Abstract:
    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.
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