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

Panagiotis Kitrou, Aneeta Parthipun, Athanasios Diamantopoulos, Ioannis Paraskevopoulos, Narayan Karunanithy, Konstantinos Katsanos*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

55 Citations (Scopus)

Abstract

Purpose: 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%). Conclusion: 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.

Original languageEnglish
Pages (from-to)538-545
Number of pages8
JournalJOURNAL OF ENDOVASCULAR THERAPY
Volume22
Issue number4
DOIs
Publication statusPublished - 1 Aug 2015

Keywords

  • Aortoiliac segment
  • Chronic total occlusion
  • Complication
  • Dissection
  • Femoropopliteal segment
  • Infrainguinal arteries
  • Re-entry device
  • Subintimal angioplasty
  • Systematic review

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