Download PDF
Semin intervent Radiol 2021; 38(04): 492-499
DOI: 10.1055/s-0041-1735607
How I Do It

Infrapopliteal Artery Chronic Total Occlusion Crossing Techniques: An Overview for Endovascular Specialists

Srini Tummala
1   Department of Interventional Radiology, University of Miami Health System, UM Miller School of Medicine, Miami, Florida
,
Andrew J. Richardson
1   Department of Interventional Radiology, University of Miami Health System, UM Miller School of Medicine, Miami, Florida
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Critical limb ischemia (CLI) is on the rise due to diabetes and chronic kidney disease (CKD). It is the most severe form of peripheral artery disease with patients presenting with rest pain and/or tissue loss. The current reported amputation and mortality rates at 1 year are 20 to 25%.[1] CLI patients often present with multilevel disease and extensively calcified long chronic total occlusions (CTOs) in the infrapopliteal arteries. Successful CTO crossing can make the difference in terms of preventing amputation and salvaging the limb. Unfortunately, crossing CTOs often results in longer procedure times; higher radiation dose to the physician, staff, and patient; and an increased chance for arterial dissection and perforation. Depending on an operator's experience, the failure rate of CTO crossing can be 20% or greater. Given the importance of a successful revascularization in this high-risk patient population, it is vital that endovascular specialists become experts at below-the-knee CTO crossing using the various techniques available today.

Disclosures

A.J.R. has no disclosures.


S.T. is a course faculty, speaker, and consultant for Bard Peripheral Vascular Inc., Abbott Vascular, Cardiovascular Systems Inc., and Terumo Interventional Systems.




Publication History

Article published online:
07 October 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Mustapha JA, Katzen BT, Neville RF. et al. Critical limb ischemia: a threat to life and limb. Endovascular Today 2019;18(05):
    PubMedGoogle Scholar
  • 2 Pernès JM, Auguste M, Borie H. et al. Infrapopliteal arterial recanalization: a true advance for limb salvage in diabetics. Diagn Interv Imaging 2015; 96 (05) 423-434
    CrossrefPubMedGoogle Scholar
  • 3 Mustapha JA, Saab F, McGoff T. et al. Tibio-pedal arterial minimally invasive retrograde revascularization in patients with advanced peripheral vascular disease: the TAMI technique, original case series. Catheter Cardiovasc Interv 2014; 83 (06) 987-994
    CrossrefPubMedGoogle Scholar
  • 4 Saab F, Jaff MR, Diaz-Sandoval LJ. et al. Chronic total occlusion crossing approach based on plaque cap morphology: the CTOP classification. J Endovasc Ther 2018; 25 (03) 284-291
    CrossrefPubMedGoogle Scholar
  • 5 Murarka S, Heuser RR. Chronic total occlusions in peripheral vasculature: techniques and devices. Expert Rev Cardiovasc Ther 2009; 7 (10) 1283-1295
    CrossrefPubMedGoogle Scholar
  • 6 Wong GB, Price MJ, Teirstein PS. Guidewire techniques and technologies: hydrophilic versus stiff wire selection. In: Handbook of Chronic Total Occlusions. CRC Press; 2007: 11
    Google Scholar
  • 7 Mariano Palena L. Below-the-knee CTO crossing strategies. Endovascular Today 2020; 19 (05) 61-62
    PubMedGoogle Scholar
  • 8 Sianos G, Werner GS, Galassi AR. et al; EuroCTO Club. Recanalisation of chronic total coronary occlusions: 2012 consensus document from the EuroCTO club. EuroIntervention 2012; 8 (01) 139-145
    CrossrefPubMedGoogle Scholar
  • 9 Timmis AD. Percutaneous transluminal coronary angioplasty: catheter technology and procedural guidelines. Br Heart J 1990; 64 (01) 32-35
    CrossrefPubMedGoogle Scholar
  • 10 Murarka SLJ, Waters KL, Scherger S, Heuser RR. Chronic total occlusions in the coronary vasculature. Cath Lab Digest; 2010: 18
    Google Scholar
  • 11 Giubilato S, Tomasello SD, Galassi AR. Percutaneous Recanalization of Chronic Total Occlusion (CTO) Coronary Arteries: Looking Back and Moving Forward. InTech Open Access Publisher; 2013
    Google Scholar
  • 12 Dave B. Recanalization of chronic total occlusion lesions: a critical appraisal of current devices and techniques. J Clin Diagn Res 2016; 10 (09) OE01-OE07
    PubMedGoogle Scholar
  • 13 Brilakis ES, Mashayekhi K, Tsuchikane E. et al. Guiding principles for chronic total occlusion percutaneous coronary intervention. Circulation 2019; 140 (05) 420-433
    CrossrefPubMedGoogle Scholar
  • 14 Mustapha J, Saab F. My favorite wires in tibial and plantar circulation: a case-based presentation. Cath Lab Digest 2018;26(02):
    PubMedGoogle Scholar
  • 15 Van Den Berg J. Use of Collaterals for Retrograde Recanalization. Endovascular Today; 2015: 72-74 , 97
    Google Scholar
  • 16 Chung J. Endovascular devices and revascularization techniques for limb-threatening ischemia in individuals with diabetes. J Diabetes Sci Technol 2017; 11 (05) 904-913
    CrossrefPubMedGoogle Scholar
  • 17 Surmely JF, Tsuchikane E, Katoh O. et al. New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique. J Invasive Cardiol 2006; 18 (07) 334-338
    PubMedGoogle Scholar
  • 18 Dash D. Guidewire crossing techniques in coronary chronic total occlusion intervention: A to Z. Indian Heart J 2016; 68 (03) 410-420
    CrossrefPubMedGoogle Scholar
  • 19 Michael TT, Papayannis AC, Banerjee S, Brilakis ES. Subintimal dissection/reentry strategies in coronary chronic total occlusion interventions. Circ Cardiovasc Interv 2012; 5 (05) 729-738
    CrossrefPubMedGoogle Scholar
  • 20 Tummala S. Below the knee interventions. Presented at Society of Interventional Radiology Global PAD Bootcamp #2. July 18, 2020
    PubMedGoogle Scholar
  • 21 Ikushima I, Hirai T, Ishii A, Iryo Y, Yamashita Y. Confluent two-balloon technique: an alternative method for subintimal recanalization of peripheral arterial occlusion. J Vasc Interv Radiol 2011; 22 (08) 1139-1143
    CrossrefPubMedGoogle Scholar
  • 22 Mustapha J. Patterns of vessel calcification in BTK arteries and implications for vessel preparation and atherectomy. LINC 2018
    PubMedGoogle Scholar
  • 23 Langhoff R. The importance of vessel preparation. Endovascular Today 2018; 6: 4-7
    PubMedGoogle Scholar