Predictors of Successful Revascularization of Chronic Total Occlusions in Superficial Femoral Arterial Lesions with Re-Entry Devices

Abstract

Peripheral arterial disease (PAD) of the lower extremities is an increasingly prevalent healthcare concern. PAD often leads to excessive buildup of plaque and eventually the formation of chronic total occlusions (CTO) in the superficial femoral artery (SFA) and other peripheral arteries. Patient symptoms and lesion severity are categorized using the Rutherford classification and the Trans-Atlantic Intersociety Consensus (TASC II) classification, respectively. TASC scores and Rutherford guidelines have helped interventionalists determine a revascularization strategy. Traditionally, surgical bypass surgery has been the default treatment option for severe SFA lesions (>10 cm), while endovascular approaches are reserved for smaller lesions. The most common endovascular approaches utilized by interventionalists for crossing CTOs are intraluminal (IL) or subintimal (SI). The SI approach creates a new extraluminal channel containing little or no atherosclerotic plaque. Re-entry devices allow operators to cross long, heavily calcified lesions in which a guidewire fails. The goal of this study was to determine the predictors of successful subintimal intervention when crossing a CTO with a re-entry device.