OUTBACK catheter for treatment of superficial femoral and iliac artery chronic total occlusion: Experience from two centers

Abstract

Purpose: The OUTBACK® catheter is a reentry device that enables reentry into a vessel lumen from the subintimal space during subintimal angioplasty. It is reserved for cases where reentry has not been possible using conventional wire and catheter techniques. We report a two-center experience in recanalization of the chronic total occlusions of the common iliac (CIA) and the superficial femoral artery (SFA) using the OUTBACK® catheter in cases where other techniques were unsuccessful. Material and Methods: All cases where recanalization was performed using the OUTBACK® reentry catheter between January 2010 to January 2015 were retrospectively identified and included in this study. 21 patients were identified. The indication for intervention in these cases included claudication and critical leg ischemia. In all cases, conventional recanalization could not be successfully achieved. Results: The OUTBACK® catheter was used to recanalize 10 SFA occlusion and 9 CIA occlusions. In 19 patients (90%), reentry into true arterial lumen was successfully achieved. 17 patients had their recanalization through the transfemoral approach whereas 2 patients had a transpopliteal artery approach. In 2 patients, reentry into the true lumen could not be achieved using the OUTBACK® catheter due to patient's intolerability for the procedure and severe atherosclerotic calcified plaques. There was 100% patency of the vessel intervened on Duplex ultrasound at 24 months of follow up. 16 patients (84%) remained asymptomatic and 2 patients (10.5%) reported worsening of their symptoms due to the development of new lesions within the arterial system. Conclusion: The OUTBACK® catheter is an effective and safe technique for reentry into the vessel lumen when conventional techniques fail.

Keywords

Chronic total occlusion - common iliac artery - OUTBACK® catheter - reentry device - superficial femoral artery

Publication History

Article published online:
30 July 2021

• References

• 1 Boguszewski A, Torey J, Pai R, Kamalakannan D, Jefic D, Davis T. Intraluminal recanalization of SFA CTOs. Endovasc Today 2010;9:33-8.
• 2 Surowiec SM, Davies MG, Eberly SW, Rhodes JM, Illig KA, Shortell CK, et al. Percutaneous angioplasty and stenting of the superficial femoral artery. J Vasc Surg 2005;41:269-78.
• 3 Scheinert D, Braunlich S, Scheinert S, Ulrich M, Biamino G, Schmidt A. Initial clinical experience with an IVUS guided transmembrane puncture device to facilitate recanalization of total femoral artery occlusion. EuroIntervention 2005;1:115-9.
• 4 Bolia A, Miles KA, Brennan J, Bell PR. Percutaneous transluminal angioplasty of occlusions of the femoral and popliteal arteries by subintimal dissection. Cardiovasc Intervent Radiol 1990;13:357-63.
• 5 Hausegger KA, Georgieva B, Portugaller H, Tauss J, Stark G. The OUTBACK ® catheter: A new device for true lumen reentry after dissection during recanalization of arterial occlusions. Cardiovasc Intervent Radiol 2004;27:26-30.
• 6 Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007;45(Suppl S):S5-67.
• 7 Lipsitz EC, Ohki T, Veith FJ, Suggs WD, Wain RA, Cynamon J, et al. Does subintimal angioplasty have a role in the treatment of severe lower extremity ischemia? J Vasc Surg 2003;37:386-91.
• 8 Bolia A. Subintimal angioplasty in lower limb ischemia. J Cardiovasc Surg 2005;46:385-94.
• 9 Gandini R, Fabiano S, Spano S, Volpi T, Morosetti D, Chiaravalloti A, et al. Randomized control study of the OUTBACK ® LTD reentry catheter versus manual reentry for the treatment of chronic total occlusions in the superficial femoral artery. Catheter Cardiovasc Interv 2013;82:485-92.
• 10 Smith M, Pappy R, Hennebry TA. Reentry devices in the treatment of peripheral chronic occlusions. Tex Heart Inst J 2011;38:392-7.
• 11 Ramjas G, Thurley P, Habib S. The use of a reentry catheter in recanalization of chronic inflow occlusions of the common iliac artery. Cardiovasc Intervent Radiol. 2008;31:650-4.
• 12 Aslam MS, Allaqaband S, Haddadian B, Mori N, Bajwa T, Mewissen M. Subintimal angioplasty with a true reentry device for treatment of chronic occlusion of the arteries of the lower extremity. Catheter Cardiovasc Interv 2013;82:701-6.
• 13 Leville CD, Kashyap VS, Clair DG, Bena JF, Lyden SP, Greenberg RK, et al. Endovascular management of iliac artery occlusions: Extending treatment to TransAtlantic Inter-Society Consensus class C and D patients. J Vasc Surg 2006;43:32-9.
• 14 Uher P, Nyman U, Lindh M, Lindblad B, Ivancev K. Long-term results of stenting for chronic iliac artery occlusion. J Endovasc Ther 2002;9:67-75.