Use, Safety and Effectiveness of Subintimal Angioplasty and Re-Entry Devices for the Treatment of Femoropopliteal Chronic Total Occlusions: A Systematic Review of 87 Studies and 4,665 Patients.

MedStar author(s):
Citation: Cardiovascular Revascularization Medicine. 21(1):34-45, 2020 01.PMID: 31054801Institution: MedStar Washington Hospital CenterumarDepartment: Medicine/General Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Angioplasty/is [Instrumentation] | *Femoral Artery | *Peripheral Arterial Disease/th [Therapy] | *Popliteal Artery | *Vascular Access Devices | Aged | Aged, 80 and over | Angioplasty/ae [Adverse Effects] | Chronic Disease | Constriction, Pathologic | Equipment Design | Female | Femoral Artery/dg [Diagnostic Imaging] | Femoral Artery/in [Injuries] | Femoral Artery/pp [Physiopathology] | Humans | Male | Middle Aged | Peripheral Arterial Disease/dg [Diagnostic Imaging] | Peripheral Arterial Disease/pp [Physiopathology] | Popliteal Artery/dg [Diagnostic Imaging] | Popliteal Artery/in [Injuries] | Popliteal Artery/pp [Physiopathology] | Risk Factors | Time Factors | Treatment Outcome | Vascular Patency | Vascular System Injuries/et [Etiology]Year: 2020Local holdings: Available in print through MWHC library: 2002 - presentISSN:
  • 1878-0938
Name of journal: Cardiovascular revascularization medicine : including molecular interventionsAbstract: BACKGROUND: Subintimal angioplasty (SIA) is often utilized to cross femoropopliteal (FP) artery chronic total occlusions (CTOs). Re-entry devices (RED) can further assist with true lumen re-entry.CONCLUSION: SIA with or without RED is a valuable alternative to intraluminal crossing for endovascular treatment of FP CTOs. Procedural success was excellent for both techniques, while the cumulative complication rate was numerically lower in the RED group. Short- and long-term outcomes were acceptable for both techniques.Copyright (c) 2019. Published by Elsevier Inc.METHODS: A systematic review according to the PRISMA guidelines was performed. Quantitative synthesis was applied when possible.OBJECTIVE: To systematically review the literature for studies reporting on the use of SIA, with or without RED.RESULTS: 87 studies and 4665 patients (5161 lesions) were included (63.9% male). 46.7% of patients had critical limb ischemia at the time of the intervention. Two RED types were used (Pioneer and Outback). Sixty-eight studies included lesions treated with SIA without RED, 17 studies included lesions treated with RED only, and two studies included a comparison between the two treatment methods. In total, 3898 (83.6%) patients were treated with SIA without RED and 754 (12.2%) with RED. Procedural success rate ranged from 64.5%-100% (92.5% for SIA without RED, 88.3% for RED cases). The complication rate ranged from 1.6% - 28% among different studies (cumulative rates: SIA: 9.1%, RED 9.3%). Perforations occurred in 1.6% of the total population (n=46). Primary patency at one year ranged from 22% to 94.1%. Newer studies had a higher patency rate, ranging from 70% to 94.1%.All authors: Armstrong EJ, Avner SJ, Bakoyiannis C, Chaitidis N, Giri JS, Jonnalagadda AK, Kakkar A, Katsaros I, Kokkinidis DG, Secemsky EAOriginally published: Cardiovascular Revascularization Medicine. 2019 Mar 23Fiscal year: FY2020Fiscal year of original publication: FY2019Digital Object Identifier: Date added to catalog: 2019-05-21
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Journal Article MedStar Authors Catalog Article 31054801 Available 31054801

Available in print through MWHC library: 2002 - present

BACKGROUND: Subintimal angioplasty (SIA) is often utilized to cross femoropopliteal (FP) artery chronic total occlusions (CTOs). Re-entry devices (RED) can further assist with true lumen re-entry.

CONCLUSION: SIA with or without RED is a valuable alternative to intraluminal crossing for endovascular treatment of FP CTOs. Procedural success was excellent for both techniques, while the cumulative complication rate was numerically lower in the RED group. Short- and long-term outcomes were acceptable for both techniques.

Copyright (c) 2019. Published by Elsevier Inc.

METHODS: A systematic review according to the PRISMA guidelines was performed. Quantitative synthesis was applied when possible.

OBJECTIVE: To systematically review the literature for studies reporting on the use of SIA, with or without RED.

RESULTS: 87 studies and 4665 patients (5161 lesions) were included (63.9% male). 46.7% of patients had critical limb ischemia at the time of the intervention. Two RED types were used (Pioneer and Outback). Sixty-eight studies included lesions treated with SIA without RED, 17 studies included lesions treated with RED only, and two studies included a comparison between the two treatment methods. In total, 3898 (83.6%) patients were treated with SIA without RED and 754 (12.2%) with RED. Procedural success rate ranged from 64.5%-100% (92.5% for SIA without RED, 88.3% for RED cases). The complication rate ranged from 1.6% - 28% among different studies (cumulative rates: SIA: 9.1%, RED 9.3%). Perforations occurred in 1.6% of the total population (n=46). Primary patency at one year ranged from 22% to 94.1%. Newer studies had a higher patency rate, ranging from 70% to 94.1%.

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