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 SS27. The Positive Effect of Reentry Device with Intravascular Ultrasound on Technical Success, Safety and Patency of Subintimal Angioplasty of Chronic Total Occlusion in Iliac Arteries

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

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