title: Crossing of infrainguinal peripheral arterial chronic total occlusion with a blunt microdissection catheter.
abstract: OBJECTIVE
  Crossing of lower-extremity arterial chronic total occlusion (CTO) can be challenging. Use of the Viance peripheral CTO crossing device (Covidien) in the superficial femoral (SFA), popliteal, and below-the knee (BTK) arterial locations has received limited study.
  
  
  METHODS
  Fifty-eight patients from the Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851) were treated between April 2010 and November 2013 with the Viance device. The procedural and 30-day clinical outcomes were collected.
  
  
  RESULTS
  Mean age was 65.5 ± 8.7 years and 55.1% had diabetes mellitus. Most lesions (n = 58) were TASC classification type C (n = 16; 27.6%) and D (n = 16; 27.6%), with mean lesion length 140.0 ± 71.0 mm; 93.1% of lesions were de novo and 81.0% were severely calcified. Technical success (crossing without the use of a reentry device) was achieved in 87.9% of cases and procedural success was obtained in 86.2%; 51.7% of lesions received stents, with the remaining treated with balloon angioplasty and/or atherectomy. Average fluoroscopy time was 39.1 ± 21.2 min, with 187.8 ± 72.0 mL of contrast and 210.0 ± 212.0 Gy cm² radiation dose-area product. There was 1 periprocedural complication (access-site hematoma treated conservatively without blood transfusion). At 30 days post procedure, there was significant improvement in ankle-brachial index (0.72 ± 0.30 to 0.84 ± 0.16; P=.01) and Rutherford class (3.33 ± 0.81 to 1.54 ± 1.47; P<.001). Clinically-indicated target vessel revascularization, surgical intervention or amputation at 30 days was 5.2%.
  
  
  CONCLUSIONS
  Use of Viance to cross infrainguinal arterial CTO was associated with high success, low complication rates, and significant symptom improvement.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas 75216 USA. subhash.banerjee@va.gov.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Rahul
authors.initials: R
authors.lastname: Thomas
authors.forename: Karan
authors.initials: K
authors.lastname: Sarode
authors.forename: Atif
authors.initials: A
authors.lastname: Mohammad
authors.forename: Salil
authors.initials: S
authors.lastname: Sethi
authors.forename: Mirza S
authors.initials: MS
authors.lastname: Baig
authors.forename: Osvaldo S
authors.initials: OS
authors.lastname: Gigliotti
authors.forename: M Ishti
authors.initials: MI
authors.lastname: Ali
authors.forename: Andrew
authors.initials: A
authors.lastname: Klein
authors.forename: Mazen S
authors.initials: MS
authors.lastname: Abu-Fadel
authors.forename: Nicolas W
authors.initials: NW
authors.lastname: Shammas
authors.forename: Anand
authors.initials: A
authors.lastname: Prasad
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D017073:Atherectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002114:Calcinosis / Q000175:diagnosis; D057785:Catheters; D057186:Comparative Effectiveness Research; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D015641:Radiography, Interventional / Q000379:methods; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome