Clinical study
Safety and Short-term Outcomes following Controlled Blunt Microdissection Revascularization of Symptomatic Arterial Occlusions of the Pelvis and Lower Extremities

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Purpose

To present the safety and short-term outcomes of using controlled blunt microdissection catheter–assisted revascularization of symptomatic chronic total occlusions of the lower extremity.

Materials and Methods

A retrospective study was performed on 61 patients (46 men) with a mean age of 72.3 years ± 9.4 who underwent 67 procedures in 86 arteries between June 2003 and March 2007 for claudication (38 procedures, 57%), rest pain (19 procedures, 28%), and tissue loss (10 procedures, 15%). Technical success was defined as successful traversal of the occlusion. Duplex ultrasonography (US) was used to assess patency. Clinical patency was defined as at least one category improvement in Rutherford score from baseline and absence of target limb revascularization or major amputation at 6 months.

Results

Chronic total occlusions were located in aortoiliac (11 arteries, 13%), infrainguinal (72 arteries, 83%), and infrapopliteal (four arteries, 5%) arteries. The mean lesion length was 14.2 cm ± 8. The tibial run-off vessels was 1.9 vessels ± 0.8. The technical success rate of the procedure was 84%. Advanced age (P = .04), renal function (P = .02), and target lesion length (P ≤ .01) were predictors of technical failure. The clinical success rate at 6 months was 92%, and the primary patency with duplex US was 87%. Renal function (P ≤ .01), length of the occlusion (P ≤.01), number of stents per procedure (P ≤.01), and tibial run-off vessels (P = .05) were the predictors of clinical success.

Conclusions

The controlled blunt microdissection catheter is safe in the revascularization of chronic total occlusions of the lower extremity. The technical success rate was 84% and predicted by age, renal function, and lesion characteristics. Clinical patency at 6 months was 92% and predicted by renal function, lesion characteristics, and run-off.

Section snippets

Materials and Methods

Institutional review board approval is not required for retrospective clinical studies at the study center. Informed consent for the procedure was obtained from all study patients. From June 2003 through March 2007, 61 consecutive patients underwent 67 procedures for 86 chronic totally occluded arteries; these patients constitute the study sample. All patients underwent controlled blunt microdissection catheter–assisted percutaneous revascularization of symptomatic arterial chronic total

Results

The study group consisted of 61 patients (46 men, 75%) with a mean age of 72.3 years ± 9.4 who underwent 67 procedures in 86 arterial segments. The cardiovascular risk factors included dyslipidemia in 61 of 61 patients (100%), hypertension in 60 (98%), smoking history in 47 (77%), coronary artery disease in 43 (70%), and diabetes mellitus in 27 (44%). The mean baseline serum creatinine level was 1.34 mg/dL ± 0.69 (118 ± 61 μmol/L; mean estimated GFR, 49.7 mL/min per 1.73 m2 body surface area ±

Discussion

In this single-center study, we present our results for safety, technical, short-term clinical, and hemodynamic success rates of controlled blunt microdissection catheter-assisted (Frontrunner XP) revascularization of symptomatic lower-extremity chronic total occlusions. The technical success rate with use of this catheter was 84%, and technical success was predicted by age, renal function, and lesion characteristics. Clinical patency at 6 months is 92% and is predicted by renal function,

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    P.A.S. is a paid consultant for Cordis. None of the other authors have identified a conflict of interest.

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    Copyright © 2009 SIR. Published by Elsevier Inc. All rights reserved.