Tareq Massimi, An Teng, Sadaf Ahanchi, David Dexter, Jung Kim, Jean Panneton
EVMS, Norfolk, VA.
OBJECTIVES: Review impact of re-entry devices (RED) on subintimal angioplasty (SIA) of iliac artery chronic total occlusion (CTO).
METHODS: We completed a retrospective review of iliac artery CTO treated with SIA from 2003-2012.
RESULTS: From 1,100 iliac interventions, 214 SIA of iliac CTOs were identified: 72 in the RED Group, 36 IVUS directed RED Group. The mean age was 63 years, males 59%, TASC B 27%, C 36% and D 37%. IVUS directed RED had a larger proportion of TASC D lesions compared to the non-RED Group (58% vs. 36%, p=0.01). Indications included claudication (66%) and CLI (34%). Clinical profile and indications were not different between groups. Technical success was 92%, with a trend towards higher technical success with a RED vs. non-RED (96% vs. 90%, p=0.1). The overall incidence of retrograde aortoiliac dissections that required treatment was 13%, and, compared to the non-RED Group, the IVUS directed RED Group had a lower incidence (3% vs. 14%, p=0.06).
The overall incidence of retrograde aortic dissections that required treatment was 8%, and, compared to the non-RED Group, the non-IVUS-directed RED Group had a higher incidence (17% vs. 6%, p=0.04). Retroperitoneal hematoma from unrecognized iliac injury occurred in 5 cases (2.5%). Compared to the 1 case in the non-RED Group, there was 1 case in the IVUS-directed RED Group (3% vs. 1%, p=0.4), and 3 cases in the non-IVUS-directed RED (8% vs. 1%, p=0.03). Primary patency for the RED Group vs. the non-RED Group at 1 and 3 years was 87% and 75% vs. 73% and 59%, respectively, with the use of a RED having a positive effect on primary patency based on multivariate analysis (HR 0.4, p=0.03). Secondary patency for the RED group vs. the non-RED group at 3 years was 87% vs. 79 % and was not statistically different (p=0.8).
CONCLUSIONS: Re-entry devices can improve technical success and primary patency of SIA recanalization of iliac artery CTO. IVUS-directed re-entry may further enhance the safety of the procedure.
AUTHOR DISCLOSURES: S. Ahanchi: Nothing to disclose; D. Dexter: Nothing to disclose; J. Kim: Nothing to disclose; T. Massimi: Nothing to disclose; J. Panneton: Medtronic, Consulting fees or other remuneration (payment); Spectranetics, Consulting fees or other remuneration (payment); A. Teng: Nothing to disclose.
Posted April 2013