title: Native chronic total occlusion recanalization after lower limb bypass graft occlusion: a series of nine cases.
abstract: OBJECTIVE
  The aim of the study was to report the clinical utility of native chronic total occlusion (CTO) recanalization as an endovascular strategy in lower limb bypass graft occlusion.
  
  
  BACKGROUND
  There is no consensus on the best approach for threatened limbs in patients with graft occlusion.
  
  
  METHODS
  The subjects were nine consecutive patients with limb-threatening ischemia after bypass graft occlusion. Native CTO recanalization was attempted endovascularly using conventional intraluminal and subintimal angioplasty techniques supported by stents.
  
  
  RESULTS
  The mean age of the bypass grafts was 6.7 +/- 7.3 (range: 1-24) months and the mean number of previous lower limb bypass surgeries was 1.4 +/- 0.5 (range: 1-2). Native CTO recanalization was performed in the iliofemoral (n = 2), iliac (n = 2), superficial femoral (n = 3), popliteal (n = 1), and popliteal-tibial (n = 1) arteries. Technical success was achieved in 89% (8/9) of cases without complications or major adverse cardiovascular events. The ankle-brachial index and skin perfusion pressure of the foot significantly increased after revascularization, with marked improvement of clinical symptoms (Rutherford class: 4.5 +/- 1.1-->0.9 +/- 1.4, P < 0.001). Limb salvage was achieved in all successful recanalization cases during the mean follow-up time of 25 +/- 20 months (range: 9-60).
  
  
  CONCLUSIONS
  In this preliminary study, endovascular recanalization of native CTO showed satisfactory outcomes in patients with bypass graft occlusion.
authors.affiliation: Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada city, Osaka, Japan. kawarada@stanford.edu
authors.forename: Osami
authors.initials: O
authors.lastname: Kawarada
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yokoi
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000295:instrumentation; D055109:Ankle Brachial Index; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007564:Japan; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D020127:Recovery of Function; D012039:Regional Blood Flow; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing