title: Technical and early outcomes using ultrasound-guided reentry for chronic total occlusions.
abstract: BACKGROUND
  Subintimal angioplasty is a common treatment for chronic total occlusions (CTOs) in the iliac and infrainguinal arteries. Although technical success has been described using intravascular ultrasound-guided reentry devices (IVUS-RED), outcomes are still not well defined. This report describes the technical aspects and longitudinal follow-up after intravascular ultrasound-guided reentry of iliac and infrainguinal CTOs.
  
  
  METHODS
  A retrospective review was performed of 20 patients with lower extremity CTO treated with IVUS-RED from 2011 to 2013. A matched cohort of patients who underwent lower extremity interventions without the use of IVUS-RED was also identified. Procedural success, patency estimates, ankle-brachial indices (ABIs), complications, and limb salvage were analyzed.
  
  
  RESULTS
  Twenty patients (mean age, 69 ± 13 years), including 11 men and 9 women, underwent attempted IVUS-RED-guided recanalization. Median follow-up was 4.3 months (range, 0.4-24). Eleven patients presented with critical limb ischemia (CLI), and 9 presented with claudication. Technical success was achieved in 18 (90%) patients. Ten common iliac arteries, 3 external iliac arteries, and 5 superficial femoral arteries (SFA) were treated. No intraoperative complications resulted from device use. After procedure, ABIs significantly increased (0.5-0.9; P < 0.01) in the 13 patients with follow-up. Primary patency for the entire cohort was 62% at 12 months. No patient treated for claudication required reintervention, whereas 3 (27%) of those treated for CLI required repeat interventions. During follow-up, 2 patients died unrelated to the procedure, 1 patient required an amputation, and 1 patient eventually required open revascularization. When the IVUS-RED group was compared with a cohort matched on Trans-Atlantic Inter-Society Consensus and age, no difference was found in runoff scores and patency between the 2 groups during follow-up (P > 0.05).
  
  
  CONCLUSIONS
  Recanalization of CTO using IVUS-RED is safe and effective. Use of IVUS-RED does not adversely impact outcomes in conjunction with other endovascular techniques. Early follow-up demonstrates acceptable patency, especially in patients with claudication, and freedom from reintervention.
authors.affiliation: Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Aaron C
authors.initials: AC
authors.lastname: Baker
authors.affiliation: Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Misty D
authors.initials: MD
authors.lastname: Humphries
authors.affiliation: Division of Vascular Surgery, David Grant Medical Center, Travis Air Force Base, CA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Noll
authors.affiliation: Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Navjeet
authors.initials: N
authors.lastname: Salhan
authors.affiliation: Division of Cardiology, VA Eastern Colorado Healthcare System and University of Colorado School of Medicine, Denver, CO.
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.affiliation: Division of Vascular Surgery, David Grant Medical Center, Travis Air Force Base, CA.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Williams
authors.affiliation: Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA; Division of Vascular Surgery, David Grant Medical Center, Travis Air Force Base, CA. Electronic address: wclouse@partners.org.
authors.forename: W Darrin
authors.initials: WD
authors.lastname: Clouse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods*; D055109:Ankle Brachial Index; D002908:Chronic Disease; D003251:Constriction, Pathologic; D016638:Critical Illness; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014654:Vascular Patency