title: Recanalization of popliteal and infrapopliteal chronic total occlusions using Viance and CrossBoss crossing catheters: a multicenter experience from the XLPAD Registry.
abstract: BACKGROUND
  Chronic total occlusions (CTOs) are reported in up to 40% of patients with symptomatic peripheral arterial disease. The Viance Crossing catheter (Covidien) and the CrossBoss catheter (Boston Scientific) are novel devices that facilitate either true lumen or subintimal navigation across CTOs. The purpose of this study was to examine the acute procedural success of these devices for popliteal and below-the-knee (BTK) CTOs.
  
  
  METHODS
  Clinical and procedural outcome data between Sept 2010 and October 2013 were analyzed from the ongoing multicenter XLPAD registry. Technical success was defined as true lumen passage of the catheter, while procedural success was defined as successful vessel revascularization inclusive of subintimal passage and reentry.
  
  
  RESULTS
  Twenty-nine patients underwent 31 procedures, in which 37 lesions were treated with the Viance and CrossBoss catheters. Mean age of the group was 69.1 ± 10.7 years and 26 patients were male (90%). All patients (100%) had hypertension, 62% were diabetic, and 48% were active smokers. Critical limb ischemia was the indication for the procedure in 58% of cases; mean Rutherford class was 4.2 ± 1.2 for the entire cohort. Target CTOs included 14 anterior tibial, 9 posterior tibial, 5 peroneal, 1 tibio-peroneal trunk, and 8 popliteal artery lesions. Mean lesion length was 81 ± 64 mm; 15 lesions (41%) were severely calcified. True lumen passage was obtained in 24 lesions (65% technical success). Subintimal entry was achieved in 5 lesions (14%). Procedural success was achieved in 26 lesions (70%). Procedural failure was related to longer lesion length (P<.001), and mean length of failed lesions was 136 ± 65 mm.
  
  
  CONCLUSIONS
  Viance and CrossBoss catheters were associated with an overall 70% procedural success with predominantly true lumen crossing in a BTK-CTO cohort. CTO length remains an important determinant of device success.
authors.affiliation: UT Health Science Center at San Antonio, Department of Medicine, Division of Cardiology, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA. anandprasadmd@gmail.com.
authors.forename: Salil
authors.initials: S
authors.lastname: Sethi
authors.forename: Atif
authors.initials: A
authors.lastname: Mohammad
authors.forename: S Hinan
authors.initials: SH
authors.lastname: Ahmed
authors.forename: Samir
authors.initials: S
authors.lastname: Germanwala
authors.forename: Karan
authors.initials: K
authors.lastname: Sarode
authors.forename: Carolina
authors.initials: C
authors.lastname: Ortiz-Lopez
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Anand
authors.initials: A
authors.lastname: Prasad
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D012042:Registries; D012720:Severity of Illness Index; D013781:Texas; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014654:Vascular Patency