国際心臓血管研究ジャーナル

Revascularization of TASC C/D Iliac Occlusion Extended to Common/Superficial Femoral Artery using a Mixed Endoluminal and Subintimal Technique through the RadioBrachial Access

Gianluca Rigatelli, Dobrin Vassiliev, Fabio dell'Avvocata,Alberto Rigatelli, Massimo Giordan and Paolo Cardaioli

 Revascularization of TASC C/D Iliac Occlusion Extended to Common/Superficial Femoral Artery using a Mixed Endoluminal and Subintimal Technique through the RadioBrachial Access

Background: Patients with Trans-Atlantic Inter Society Consensus (TASC) C and D iliac lesions extended to common and/or superficial femoral artery are a very challenging subset of patients. Objective: The aim of this study is to discuss the technical implication and short-term outcome of endovascular revascularization through the radio-brachial access using a mixed endoluminal and subintimal recanalization using a Mmxed endoluminal and subintimal technique. Methods: From January 2010 to Jannuary 2015 We prospectively enrolled 33 consecutive patients (mean age 79 ± 12.5 years) , with long (>80 mm) TASC C and TASC D symptomatic chronic iliac arteries occlusion extended to the common/superficial femoral artery, judged not candidates for surgery. Procedure was attempted through the left radial or brachial artery by means of a mixed endoluminal and subintimal recanalization technique using coronary and peripheral dedicated guidewires. Results: The procedure was successful in all but one case (96.9%), mean length and diameter of implanted stents were 160.4 ± 30.2 mm and 8.6 ± 1.4 mm (Everflex EV3 in 20 patients, Pulsar in 3 patients, Smart Flex in 10 patients) , respectively. The procedure was successful in 32/33 patients (96.9%): mean length and diameter of implanted stents were 160.4 ± 30.2 mm and 8.6 ± 1.4 mm (Everflex EV3 in 20 patients, Pulsar in 2 patients, Smart Flex in 10 patients) , respectively. Complications rate was 9.1% including two vessel ruptures and one distal embolization. Death rate was 3%. At a mean follow up of 18.1 ± 11.2 montshs, the primary and secondary patency rates were 90.1 and 96.9%, respectively with a significant improvement of ABI (0.29 ± 0.6 versus 0.88 ± 0.3, p<00.1) and Rutherford class (5.3 ± 0.8 versus 0.7 ± 1.9, P <0.01) compared to baseline. Conclusion: The described technique appeared to be effective and safe allowing for recanalization of long iliac occlusion extended to common/superficial femoral artery.