Safety and short-term outcomes following controlled blunt microdissection revascularization of symptomatic arterial occlusions of the pelvis and lower extremities.
OBJECTIVE
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.


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 < or = .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 < or = .01), length of the occlusion (P < or =.01), number of stents per procedure (P < or =.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.
Thatipelli
Mallik R
MR
Section of Vascular Medicine, St Elizabeth's Medical Center, Boston, Massachusetts, USA.
Misra
Sanjay
S
Sanikommu
Srinivas R
SR
Schainfeld
Robert M
RM
Soukas
Peter A
PA
D000367:Age Factors; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002908:Chronic Disease; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D042282:Microdissection / Q000009:adverse effects; D019060:Minimally Invasive Surgical Procedures; D010388:Pelvis / Q000098:blood supply*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency