title: Outback catheter for femoropopliteal occlusions: immediate and long-term results.
abstract: OBJECTIVE
  To report a retrospective, single-center study that evaluates technical and clinical outcomes from subintimal recanalization of femoropopliteal chronic total occlusions (CTO) facilitated by the Outback re-entry catheter.
  
  
  METHODS
  The Outback catheter was required to complete recanalization of femoropopliteal CTOs (mean lesion length 195 ± 91 mm) in 118 limbs of 113 patients (77 men; mean age 70 ± 10 years). In 80/118 (67.8%) limbs, treatment was performed for claudication and in the remaining 38 (32.2%) for critical limb ischemia (CLI). Technical and procedural success, clinical outcome, and cumulative patency rates in follow-up were evaluated.
  
  
  RESULTS
  Re-entry was accomplished in 108/118 limbs (91.5%) with recanalization completed in 107/118 (90.7%). Of these, only 61/107 (57%) arteries were left with a residual stenosis <30%. Complications included minor bleeding of the target vessel (5/118, 4.2%) and minor hematoma/pseudoaneurysm at the access site (6/118, 5.1%). Acute reocclusion developed in 2/118 cases (1.7%) without major complication. After 12 months, primary patency was 56.7%, assisted primary patency 83.1%, and secondary patency 89.1%. Primary patency was significantly reduced in limbs with residual stenosis. Over a median 15-month follow-up (range 2-32), 4 major and 2 minor amputations were performed in patients with CLI.
  
  
  CONCLUSIONS
  The Outback catheter is a reliable tool to recanalize challenging chronic femoropopliteal occlusions after failed guidewire re-entry. Restenosis rates are high, which may be due to the severity and extent of disease in these patients, who are particularly challenging.
authors.affiliation: Centre of Vascular Medicine, Angiology and Vascular Surgery, Park Hospital Leipzig, Germany. ybausback@yahoo.de
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Bausback
authors.forename: Spiridon
authors.initials: S
authors.lastname: Botsios
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Flux
authors.forename: Martin
authors.initials: M
authors.lastname: Werner
authors.forename: Johannes
authors.initials: J
authors.lastname: Schuster
authors.forename: Jairam
authors.initials: J
authors.lastname: Aithal
authors.forename: Ramon
authors.initials: R
authors.lastname: Varcoe
authors.forename: Sven
authors.initials: S
authors.lastname: Bräunlich
authors.forename: Matthias
authors.initials: M
authors.lastname: Ulrich
authors.forename: Dierk
authors.initials: D
authors.lastname: Scheinert
authors.forename: Andrej
authors.initials: A
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D057785:Catheters; D003251:Constriction, Pathologic; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D005858:Germany; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency