Percutaneous Intentional Extraluminal Recanalization of Chronic Total Occlusions: A Review of Reentry Devices

Abstract

Percutaneous intentional extraluminal recanalization (PIER) is an endovascular subintimal crossing technique used to treat chronic total occlusions (CTOs) of the peripheral arteries. Intraluminal revascularization remains the standard over PIER when technically feasible; however, when intraluminal approaches fail, PIER may be preferred prior to pursuit of surgical bypass grafting. The major cause of failure of PIER is inability to reenter the true lumen after crossing the CTO. Therefore, several reentry devices and endovascular techniques have been developed to allow for the operators to safely and quickly access the true lumen distal to the occlusion. Reentry devices currently available on the market include the Pioneer Plus catheter, Outback Elite catheter, OffRoad catheter, Enteer catheter, and GoBack catheter. These devices have unique methods of use and specific advantages with regard to their technical success along with reduced procedural and fluoroscopic time. In addition, there are other endovascular techniques available that may facilitate true lumen reentry and these will also be reviewed.

Keywords

interventional radiology - peripheral arterial disease - arterial interventions - reentry - technique

Publikationsverlauf

Artikel online veröffentlicht:
16. Juni 2023

• References

• 1 Myers SI, Myers DJ, Ahmend A, Ramakrishnan V. Preliminary results of subintimal angioplasty for limb salvage in lower extremities with severe chronic ischemia and limb-threatening ischemia. J Vasc Surg 2006; 44 (06) 1239-1246
• 2 Bolia A, Miles KA, Brennan J, Bell PR. Percutaneous transluminal angioplasty of occlusions of the femoral and popliteal arteries by subintimal dissection. Cardiovasc Intervent Radiol 1990; 13 (06) 357-363
• 3 London NJ, Srinivasan R, Naylor AR. et al. Subintimal angioplasty of femoropopliteal artery occlusions: the long-term results. Eur J Vasc Surg 1994; 8 (02) 148-155
• 4 Ko YG, Shin S, Kim KJ. et al. Efficacy of stent-supported subintimal angioplasty in the treatment of long iliac artery occlusions. J Vasc Surg 2011; 54 (01) 116-122
• 5 Keeling AN, Khalidi K, Leong S. et al. Subintimal angioplasty: predictors of long-term success. J Vasc Interv Radiol 2009; 20 (08) 1013-1022
• 6 Siablis D, Diamantopoulos A, Katsanos K. et al. Subintimal angioplasty of long chronic total femoropopliteal occlusions: long-term outcomes, predictors of angiographic restenosis, and role of stenting. Cardiovasc Intervent Radiol 2012; 35 (03) 483-490
• 7 Tisi PV, Mirnezami A, Baker S, Tawn J, Parvin SD, Darke SG. Role of subintimal angioplasty in the treatment of chronic lower limb ischaemia. Eur J Vasc Endovasc Surg 2002; 24 (05) 417-422
• 8 Gastaldo F, Tirukonda P, Yip G, Patlas M. Subintimal recanalization of peripheral chronic occlusive arterial disease with modified transseptal needle. J Vasc Interv Radiol 2013; 24 (02) 184-189
• 9 Lipsitz EC, Ohki T, Veith FJ. et al. Does subintimal angioplasty have a role in the treatment of severe lower extremity ischemia?. J Vasc Surg 2003; 37 (02) 386-391
• 10 Yilmaz S, Sindel T, Yegin A, Lüleci E. Subintimal angioplasty of long superficial femoral artery occlusions. J Vasc Interv Radiol 2003; 14 (08) 997-1010
• 11 Kokkinidis DG, Katsaros I, Jonnalagadda AK. et al. Use, safety and effectiveness of subintimal angioplasty and re-entry devices for the treatment of iliac artery chronic total occlusions: a systematic review of 30 studies and 1112 lesions. Cardiovasc Revasc Med 2020; 21 (03) 334-341
• 12 Hong SJ, Ko YG, Kim JS, Hong MK, Jang Y, Choi D. Midterm outcomes of subintimal angioplasty supported by primary proximal stenting for chronic total occlusion of the superficial femoral artery. J Endovasc Ther 2013; 20 (06) 782-791
• 13 Schmieder GC, Richardson AI, Scott EC, Stokes GK, Meier III GH, Panneton JM. Selective stenting in subintimal angioplasty: analysis of primary stent outcomes. J Vasc Surg 2008; 48 (05) 1175-1180 , discussion 1180–1181
• 14 Treiman GS, Treiman R, Whiting J. Results of percutaneous subintimal angioplasty using routine stenting. J Vasc Surg 2006; 43 (03) 513-519
• 15 Scott EC, Biuckians A, Light RE. et al. Subintimal angioplasty for the treatment of claudication and critical limb ischemia: 3-year results. J Vasc Surg 2007; 46 (05) 959-964
• 16 Flørenes T, Bay D, Sandbaek G. et al. Subintimal angioplasty in the treatment of patients with intermittent claudication: long term results. Eur J Vasc Endovasc Surg 2004; 28 (06) 645-650
• 17 Tartari S, Zattoni L, Rolma G, Sacco A. Subintimal angioplasty of infrapopliteal artery occlusions in the treatment of critical limb ischaemia. Short-term results. Radiol Med (Torino) 2004; 108 (03) 265-274
• 18 Hynes N, Akhtar Y, Manning B. et al. Subintimal angioplasty as a primary modality in the management of critical limb ischemia: comparison to bypass grafting for aortoiliac and femoropopliteal occlusive disease. J Endovasc Ther 2004; 11 (04) 460-471
• 19 Desgranges P, Boufi M, Lapeyre M. et al. Subintimal angioplasty: feasible and durable. Eur J Vasc Endovasc Surg 2004; 28 (02) 138-141
• 20 Schneider JR, Verta MJ, Alonzo MJ, Hahn D, Patel NH, Kim S. Results with Viabahn-assisted subintimal recanalization for TASC C and TASC D superficial femoral artery occlusive disease. Vasc Endovascular Surg 2011; 45 (05) 391-397
• 21 Spinosa DJ, Leung DA, Matsumoto AH. et al. Percutaneous intentional extraluminal recanalization in patients with chronic critical limb ischemia. Radiology 2004; 232 (02) 499-507
• 22 Spinosa DJ, Leung DA, Harthun NL. et al. Simultaneous antegrade and retrograde access for subintimal recanalization of peripheral arterial occlusion. J Vasc Interv Radiol 2003; 14 (11) 1449-1454
• 23 Spinosa DJ, Harthun NL, Bissonette EA. et al. Subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) for subintimal recanalization to treat chronic critical limb ischemia. J Vasc Interv Radiol 2005; 16 (01) 37-44
• 24 Patrone L, Dharmarajah B, Korosoglou G. et al. Retrograde use of the Outback re-entry catheter in complex infrainguinal arterial recanalizations. J Vasc Surg 2022; 75 (01) 177-185.e1
• 25 Baker AC, Humphries MD, Noll Jr RE. et al. Technical and early outcomes using ultrasound-guided reentry for chronic total occlusions. Ann Vasc Surg 2015; 29 (01) 55-62
• 26 Jacobs DL, Motaganahalli RL, Cox DE, Wittgen CM, Peterson GJ. True lumen re-entry devices facilitate subintimal angioplasty and stenting of total chronic occlusions: initial report. J Vasc Surg 2006; 43 (06) 1291-1296
• 27 Tsitsiou Y, Ekpe J, Harris L, Kashef E, Hamady M. Use and effectiveness of Pioneer re-entry device for subintimal true lumen re-entry: single-centre data and a review of the literature. CVIR Endovasc 2021; 4 (01) 81
• 28 Sheikh AB, Llanos-Chea F, Jelani QUA. et al. Safety and efficacy outcomes of the Pioneer Plus catheter in endovascular revascularization of lower extremity chronic total occlusions. J Vasc Surg 2021; 74 (03) 746-755
• 29 Chen WP, Berman SS, Rainwater J, Pacanowski Jr JP, Leon Jr LR. The use of re-entry devices through pedal arterial access in the management of chronic limb-threatening ischemia. Vasc Endovascular Surg 2022; 56 (04) 432-438
• 30 Pescatori LC, Tacher V, Kobeiter H. The use of re-entry devices in aortoiliac occlusive disease. Front Cardiovasc Med 2020; 7: 144
• 31 Kitrou P, Parthipun A, Diamantopoulos A, Paraskevopoulos I, Karunanithy N, Katsanos K. Targeted true lumen re-entry with the outback catheter: accuracy, success, and complications in 100 peripheral chronic total occlusions and systematic review of the literature. J Endovasc Ther 2015; 22 (04) 538-545
• 32 Setacci C, Chisci E, de Donato G, Setacci F, Iacoponi F, Galzerano G. Subintimal angioplasty with the aid of a re-entry device for TASC C and D lesions of the SFA. Eur J Vasc Endovasc Surg 2009; 38 (01) 76-87
• 33 Aslam MS, Allaqaband S, Haddadian B, Mori N, Bajwa T, Mewissen M. Subintimal angioplasty with a true reentry device for treatment of chronic total occlusion of the arteries of the lower extremity. Catheter Cardiovasc Interv 2013; 82 (05) 701-706
• 34 Etezadi V, Benenati JF, Patel PJ, Patel RS, Powell A, Katzen BT. The reentry catheter: a second chance for endoluminal reentry at difficult lower extremity subintimal arterial recanalizations. J Vasc Interv Radiol 2010; 21 (05) 730-734
• 35 Ramjas G, Thurley P, Habib S. The use of a re-entry catheter in recanalization of chronic inflow occlusions of the common iliac artery. Cardiovasc Intervent Radiol 2008; 31 (03) 650-654
• 36 Shin SH, Baril D, Chaer R, Rhee R, Makaroun M, Marone L. Limitations of the Outback LTD re-entry device in femoropopliteal chronic total occlusions. J Vasc Surg 2011; 53 (05) 1260-1264
• 37 Rippel K, Ruhnke H, Jehs B, Decker J, Kroencke T, Scheurig-Muenkler C. Targeted tibio-peroneal re-entry during subintimal revascularization using the Outback® catheter. CVIR Endovasc 2021; 4 (01) 18
• 38 Gandini R, Fabiano S, Spano S. et al. Randomized control study of the outback LTD reentry catheter versus manual reentry for the treatment of chronic total occlusions in the superficial femoral artery. Catheter Cardiovasc Interv 2013; 82 (03) 485-492
• 39 Hayakawa N, Kodera S, Arakawa M, Kanda J. Successful re-entry using the outback® elite catheter via retrograde popliteal access with IVUS guidance for femoropopliteal occlusion: a case report. CVIR Endovasc 2020; 3 (01) 63
• 40 Gorenchtein M, Rajper N, Green P. et al. Transpedal approach for femoral-popliteal chronic total occlusions using the outback® elite re-entry device. CVIR Endovasc 2021; 4 (01) 9
• 41 Vuruskan E, Saracoglu E. Procedural and early outcomes of two re-entry devices for subintimal recanalization of aortoiliac and femoropopliteal chronic total occlusions. Korean Circ J 2017; 47 (01) 89-96
• 42 Airoldi F, Faglia E, Losa S. et al. A novel device for true lumen re-entry after subintimal recanalization of superficial femoral arteries: first-in-man experience and technical description. Cardiovasc Intervent Radiol 2011; 34 (01) 166-169
• 43 Schmidt A, Keirse K, Blessing E, Langhoff R, Diaz-Cartelle J. European Study Group. Offroad re-entry catheter system for subintimal recanalization of chronic total occlusions in femoropopliteal arteries: primary safety and effectiveness results of the re-route trial. J Cardiovasc Surg (Torino) 2014; 55 (04) 551-558
• 44 Banerjee S, Thomas R, Sarode K. et al. Crossing of infrainguinal peripheral arterial chronic total occlusion with a blunt microdissection catheter. J Invasive Cardiol 2014; 26 (08) 363-369
• 45 Bakker O, Bausback Y, Wittig T. et al. First experience with the GoBack-Catheter for successful crossing of complex chronic total occlusions in lower limb arteries. J Endovasc Ther 2022; 29 (05) 798-807