title: Targeted True Lumen Re-Entry With the Outback Catheter: Accuracy, Success, and Complications in 100 Peripheral Chronic Total Occlusions and Systematic Review of the Literature.
abstract: OBJECTIVE
  To report a single-center experience with the Outback re-entry device for targeted distal true lumen re-entry during subintimal recanalization of chronic total occlusions (CTOs) and compare the results with a systematic review of the literature.
  
  
  METHODS
  Between February 2011 and July 2013, 104 Outback devices were employed in 91 patients (mean age 64±9 years; 57 men) for subintimal recanalization of 100 vessels with CTOs after initial failure of spontaneous reentry. Fifty-two cases involved a retrograde approach to aortoiliac occlusions and 48 were re-entry attempts in infrainguinal CTOs. Outcome measures included complications and technical success, defined as successful targeted re-entry at the preplanned site of the distal true lumen. To evaluate device accuracy, the re-entry distance (between the point of true vessel reconstitution and the eventual re-entry point) was measured.
  
  
  RESULTS
  Outback success was 93% (93/100); only 7 cases failed owing to heavy calcification (5/52 aortoiliac vs 2/48 infrainguinal, p=0.44). Re-entry was highly accurate, with a re-entry distance of ~1 cm in both subgroups (1.2±0.1 cm in aortoiliac vs 1.3±0.1 cm in infrainguinal, p=0.40). There were no major and 17 minor complications (9/52 aortoiliac vs 8/48 infrainguinal, p=0.93). Results are in line with the systematic review that identified 11 studies (only 1 randomized trial) involving mostly the femoropopliteal segment (119 aortoiliac and 464 infrainguinal segments). The pooled Outback success rate was 90% (95% confidence interval 85% to 94%) and the pooled complication rate was 4.3% (95% confidence interval 1.6% to 8.3%).
  
  
  CONCLUSIONS
  The Outback device is safe and has a very high rate of achieving targeted true lumen re-entry, which minimizes the sacrifice of healthy vessel in the aortoiliac and infrainguinal arteries.
authors.affiliation: Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, UK.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kitrou
authors.affiliation: Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, UK.
authors.forename: Aneeta
authors.initials: A
authors.lastname: Parthipun
authors.affiliation: Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, UK.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Diamantopoulos
authors.affiliation: Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, UK.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Paraskevopoulos
authors.affiliation: Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, UK.
authors.forename: Narayan
authors.initials: N
authors.lastname: Karunanithy
authors.affiliation: Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, UK konstantinos.katsanos@gstt.nhs.uk.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Katsanos
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D002406:Catheterization, Peripheral / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007083:Iliac Artery; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011150:Popliteal Artery; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D062666:Vascular Access Devices
keywords: aortoiliac segment; chronic total occlusion; complication; dissection; femoropopliteal segment; infrainguinal arteries; re-entry device; subintimal angioplasty; systematic review