title: Bidirectional endovascular treatment for chronic total occlusive lesions of the femoropopliteal arterial segment using a hand-carried ultrasound device and a retrograde microcatheter.
abstract: BACKGROUND
  Although endovascular therapy for complex lesions in the lower limbs has frequently achieved successful recanalization by improvement of techniques and devices, chronic total occlusion in the femoropopliteal arterial segment still remains a challenge for treatment by endovascular therapy. We investigated the efficacy and safety of endovascular therapy for chronic total occlusion in the femoropopliteal arterial segment guided by a hand-carried ultrasound (HCUS) device and supported by a retrograde microcatheter.
  
  
  METHODS
  We attempted endovascular therapy for chronic total occlusion lesions in the femoropopliteal arterial segment using a protocol involving a dual-access procedure using the HCUS device and a retrograde 2.7F microcatheter from January 2008 to June 2010. We evaluated the success rate, complications, and clinical outcomes, including the ankle-brachial index (ABI) and primary and secondary patency.
  
  
  RESULTS
  Success was achieved in 18 of 19 patients (95%), without major complications (only two small hematomas). The HCUS device was useful in reducing the personnel and space requirements, radiation exposure, and the required amount of contrast agent. The retrograde flexible 2.7F microcatheter was also useful in achieving successful recanalization and contributed to reducing puncture-related complications. The ABI was significantly improved, from 0.56 ± 0.12 to 0.81 ± 0.11 at 1 year (P < .01) and this effect remained stable. Primary and secondary patency was 63% and 89%, respectively, at 3 years.
  
  
  CONCLUSIONS
  HCUS-guided and retrograde 2.7F microcatheter-supported endovascular therapy for chronic total occlusion lesions of the femoropopliteal arterial segment can achieve a favorable clinical outcome without major complications.
authors.affiliation: Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan. mnishino@orh.go.jp
authors.forename: Masami
authors.initials: M
authors.lastname: Nishino
authors.forename: Masayuki
authors.initials: M
authors.lastname: Taniike
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Makino
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kato
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Egami
authors.forename: Ryu
authors.initials: R
authors.lastname: Shutta
authors.forename: Jun
authors.initials: J
authors.lastname: Tanouchi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D002406:Catheterization, Peripheral / Q000295:instrumentation*; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications; D012008:Recurrence; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000295:instrumentation*; D014654:Vascular Patency