title: Endovascular recanalization of native chronic total occlusions in patients with failed lower-extremity bypass grafts.
abstract: OBJECTIVE
  To investigate the feasibility, safety, and outcome of endovascular recanalization of native chronic total occlusions (CTOs) in patients with failed lower-extremity bypass grafts.
  
  
  METHODS
  Retrospective review of 19 limbs in 18 patients with failed lower-extremity bypass grafts that underwent recanalization of native arterial occlusions between February 2009 and April 2013 was performed. Nine of the limbs presented with acute ischemia and 10 presented with chronic ischemia, including eight with critical limb ischemia and two with disabling claudication.
  
  
  RESULTS
  The mean patency of the failed bypass grafts (63% venous) was 27 months. All limbs had Transatlantic Inter-Society Consensus class D lesions involving the native circulation. Technical success of the endovascular recanalization procedure was achieved in all but one limb (95%). The mean ankle brachial indices before and after treatment were 0.34 and 0.73, respectively. There were no major complications or emergency amputations. Mean patient follow-up was 64 weeks, and two patients were lost to follow-up. Primary patency rates at 3, 6, and 12 months were 87%, 48%, and 16%, respectively. Successful secondary procedures were performed in seven patients, with secondary patency rates at 3, 6, and 12 months of 88%, 73%, and 44%, respectively. Limb salvage rates at 12 and 24 months were 94% and 65%, and amputation-free survival rates at 12 and 24 months were 87% and 60%, respectively.
  
  
  CONCLUSIONS
  Endovascular recanalization of native CTOs in patients with failed lower-extremity bypass grafts is technically feasible and safe and results in acceptable limb salvage.
authors: Department of Interventional Radiology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718.
authors: Clinton W
authors: CW
authors: Wrigley
authors: Department of Interventional Radiology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718.
authors: Ansar
authors: A
authors: Vance
authors: Department of Interventional Radiology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718.
authors: Timothy
authors: T
authors: Niesen
authors: Department of Interventional Radiology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718.
authors: Christopher
authors: C
authors: Grilli
authors: Department of Interventional Radiology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718.
authors: J Daniel
authors: JD
authors: Velez
authors: Department of Interventional Radiology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718.
authors: Demetrios J
authors: DJ
authors: Agriantonis
authors: Department of Interventional Radiology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718.
authors: George
authors: G
authors: Kimbiris
authors: Department of Interventional Radiology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718.
authors: Mark J
authors: MJ
authors: Garcia
authors: Department of Interventional Radiology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718. Electronic address: dleung@christianacare.org.
authors: Daniel A
authors: DA
authors: Leung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002908:Chronic Disease; D016638:Critical Illness; D018572:Disease-Free Survival; D057510:Endovascular Procedures; D005240:Feasibility Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D014654:Vascular Patency