Sadaf S. Ahanchi, Brian Chen, Samuel Steerman, Richard Redlinger, Jean M. Panneton
Department of Surgery Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA.
OBJECTIVES: Our aim was to analyze the effect of reentry device use on iliac artery chronic total occlusion (CTO) recanalization outcomes.
METHODS: A retrospective review of patients with iliac artery CTO treated with subintimal angioplasty (SIA) from 2006 to 2011 was completed. We then compared the outcomes of two groups: those procedures completed with vs. those procedures completed without a reentry device using SPSS software (IBM, Armonk, New York).
RESULTS: Of the 121 iliac artery CTOs that underwent SIA, 32 cases used a reentry device while 89 did not. For the entire cohort, the mean age was 65, male 45%, hypertension 76%, hyperlipidemia 71%, diabetes 36%, and CAD 56%. Indications for the procedure included claudication (60%) and critical limb ischemia (40%). The clinical profile and indications for intervention were not statistically different for the 2 groups. Combining TASC C&D lesions, the reentry device group had a trend toward a higher percentage of more advanced lesions compared to the non-reentry device group (82% vs. 66% p=0.07). Yet despite the more advanced lesions, the technical success rate was higher in the reentry device group (100% vs. 77% p=0.002). Combined major complication rate, retrograde aortic dissection, and 30-day mortality rate of the reentry group was also reduced (0% vs. 10% p=0.04). Lastly, the 1, 2 and 3 years primary and secondary patency rates, especially with long term follow up, appear to be improved with the use of reentry devices; primary patency at 1, 2, and 3 years for the reentry device group vs. the non-reentry device group (100%, 100%, 100% vs. 84%, 72%, 64% p=0.02), and secondary patency at 1, 2, and 3 years for the reentry device group vs. the non-reentry device group (100%, 100%, 100% vs. 93%, 91%, 77% p=0.125).
CONCLUSIONS: The routine use of reentry devices further improves the technical success, safety, and primary patency of SIA recanalization of iliac artery CTO.
AUTHOR DISCLOSURES: S. S. Ahanchi, Nothing to disclose; B. Chen, Nothing to disclose; J. M. Panneton, Nothing to disclose; R. Redlinger, Nothing to disclose; S. Steerman, Nothing to disclose.
Posted April 2012