title: Subintimal recanalization of peripheral chronic occlusive arterial disease with modified transseptal needle.
abstract: OBJECTIVE
  To report an alternative technique of subintimal recanalization of chronically occluded lower-extremity arteries using a modified transseptal needle (MTSN) to reenter the true lumen.
  
  
  METHODS
  From December 2008 to December 2010, 98 patients with chronic arterial occlusions were treated with endovascular techniques. True lumen reentry with conventional subintimal techniques failed in 23 of these patients (24%). Retrospective review of medical records and procedure data was performed, and clinical presentation, lesion location, Trans-Atlantic Inter-Society Consensus II classification, amount of calcification, procedure time, recanalization time with conventional subintimal technique, recanalization time with the MTSN, and complications were recorded. During the 24-month period, 11 common iliac arteries (CIAs), three external iliac arteries (EIAs), one combined CIA/EIA, six superficial femoral arteries (SFAs), and two combined SFA/popliteal arteries were treated with MTSNs.
  
  
  RESULTS
  Successful recanalization with the MTSN was obtained in 21 patients (91%). There was one complication of pseudoaneurysm formation in the EIA. The average occlusion length of the CIA was 6.7 cm; that of the SFA was 15.9 cm. The average procedure time was 73 minutes, with 20 minutes used to attempt to reenter the true lumen and 6.3 minutes used to reenter the true lumen with the MTSN.
  
  
  CONCLUSIONS
  The MTSN technique is safe and effective and offers another approach to reenter the true lumen of chronic total arterial occlusions during subintimal recanalization in difficult cases.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Hamilton General Hospital, McMaster University, 237 Barton St E, Hamilton, ON, Canada L8L 2X2. gastaldorx@gmail.com
authors.forename: Fernando
authors.initials: F
authors.lastname: Gastaldo
authors.forename: Prasanna
authors.initials: P
authors.lastname: Tirukonda
authors.forename: Gordon
authors.initials: G
authors.lastname: Yip
authors.forename: Michael
authors.initials: M
authors.lastname: Patlas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000295:instrumentation* / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002908:Chronic Disease; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009339:Needles; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D017539:Tunica Intima / Q000601:surgery*