title: Impact of aggressive endovascular recanalization techniques on success rate in chronic total arterial occlusions (CTOs).
abstract: OBJECTIVE
  To report experience with aggressive recanalization approaches in chronic total arterial occlusion (CTO).
  
  
  METHODS
  Chronic total arterial occlusion recanalization was attempted on 112 limbs in 99 consecutive patients between January 1999 and December 2006.
  
  
  RESULTS
  There were 63 iliac arteries, 45 femoropopliteal arteries, and 4 occluded stents. Mean occlusion length was 8.7 ± 4.7 cm. Conventional recanalization was attempted first and was successful in 71 limbs (70%). Probing with the guidewire's stiff end was attempted in 33 of the 41 procedures where conventional techniques failed and was successful in 18 (54%), improving the overall procedural success rate to 80%. For the remaining 15 limbs, home-made directional sharp needle recanalization was attempted in 11 and was successful in 9 (82%), further improving the overall recanalization success to 88%. Procedural complications were self-limited or managed nonoperatively.
  
  
  CONCLUSIONS
  Aggressive recanalization techniques in CTO following failure of traditional means are safe and can substantially improve procedural success rates.
authors.affiliation: Department of Surgery, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA 52242, USA. mel-sharafuddin@uiowa.edu
authors.forename: Melhem J
authors.initials: MJ
authors.lastname: Sharafuddin
authors.forename: Jamal J
authors.initials: JJ
authors.lastname: Hoballah
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Kresowik
authors.forename: Rachael M
authors.initials: RM
authors.lastname: Nicholson
authors.forename: William J
authors.initials: WJ
authors.lastname: Sharp
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology; D007484:Iowa; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000503:physiopathology; D015641:Radiography, Interventional; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency