Safety and Short-term Outcomes following Controlled Blunt Microdissection Revascularization of Symptomatic Arterial Occlusions of the Pelvis and Lower Extremities

Mallik R. Thatipelli, Sanjay Misra, Srinivas R. Sanikommu, Robert M. Schainfeld, Peter A. Soukas

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: To present the safety and short-term outcomes of using controlled blunt microdissection catheter-assisted revascularization of symptomatic chronic total occlusions of the lower extremity. Materials and Methods: A retrospective study was performed on 61 patients (46 men) with a mean age of 72.3 years ± 9.4 who underwent 67 procedures in 86 arteries between June 2003 and March 2007 for claudication (38 procedures, 57%), rest pain (19 procedures, 28%), and tissue loss (10 procedures, 15%). Technical success was defined as successful traversal of the occlusion. Duplex ultrasonography (US) was used to assess patency. Clinical patency was defined as at least one category improvement in Rutherford score from baseline and absence of target limb revascularization or major amputation at 6 months. Results: Chronic total occlusions were located in aortoiliac (11 arteries, 13%), infrainguinal (72 arteries, 83%), and infrapopliteal (four arteries, 5%) arteries. The mean lesion length was 14.2 cm ± 8. The tibial run-off vessels was 1.9 vessels ± 0.8. The technical success rate of the procedure was 84%. Advanced age (P = .04), renal function (P = .02), and target lesion length (P ≤ .01) were predictors of technical failure. The clinical success rate at 6 months was 92%, and the primary patency with duplex US was 87%. Renal function (P ≤ .01), length of the occlusion (P ≤.01), number of stents per procedure (P ≤.01), and tibial run-off vessels (P = .05) were the predictors of clinical success. Conclusions: The controlled blunt microdissection catheter is safe in the revascularization of chronic total occlusions of the lower extremity. The technical success rate was 84% and predicted by age, renal function, and lesion characteristics. Clinical patency at 6 months was 92% and predicted by renal function, lesion characteristics, and run-off.

Original languageEnglish (US)
Pages (from-to)1541-1547
Number of pages7
JournalJournal of Vascular and Interventional Radiology
Volume20
Issue number12
DOIs
StatePublished - Dec 2009

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Microdissection
Pelvis
Lower Extremity
Safety
Arteries
Kidney
Ultrasonography
Catheters
Amputation
Stents
Extremities
Retrospective Studies
Pain

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Safety and Short-term Outcomes following Controlled Blunt Microdissection Revascularization of Symptomatic Arterial Occlusions of the Pelvis and Lower Extremities. / Thatipelli, Mallik R.; Misra, Sanjay; Sanikommu, Srinivas R.; Schainfeld, Robert M.; Soukas, Peter A.

In: Journal of Vascular and Interventional Radiology, Vol. 20, No. 12, 12.2009, p. 1541-1547.

Research output: Contribution to journalArticle

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title = "Safety and Short-term Outcomes following Controlled Blunt Microdissection Revascularization of Symptomatic Arterial Occlusions of the Pelvis and Lower Extremities",
abstract = "Purpose: To present the safety and short-term outcomes of using controlled blunt microdissection catheter-assisted revascularization of symptomatic chronic total occlusions of the lower extremity. Materials and Methods: A retrospective study was performed on 61 patients (46 men) with a mean age of 72.3 years ± 9.4 who underwent 67 procedures in 86 arteries between June 2003 and March 2007 for claudication (38 procedures, 57{\%}), rest pain (19 procedures, 28{\%}), and tissue loss (10 procedures, 15{\%}). Technical success was defined as successful traversal of the occlusion. Duplex ultrasonography (US) was used to assess patency. Clinical patency was defined as at least one category improvement in Rutherford score from baseline and absence of target limb revascularization or major amputation at 6 months. Results: Chronic total occlusions were located in aortoiliac (11 arteries, 13{\%}), infrainguinal (72 arteries, 83{\%}), and infrapopliteal (four arteries, 5{\%}) arteries. The mean lesion length was 14.2 cm ± 8. The tibial run-off vessels was 1.9 vessels ± 0.8. The technical success rate of the procedure was 84{\%}. Advanced age (P = .04), renal function (P = .02), and target lesion length (P ≤ .01) were predictors of technical failure. The clinical success rate at 6 months was 92{\%}, and the primary patency with duplex US was 87{\%}. Renal function (P ≤ .01), length of the occlusion (P ≤.01), number of stents per procedure (P ≤.01), and tibial run-off vessels (P = .05) were the predictors of clinical success. Conclusions: The controlled blunt microdissection catheter is safe in the revascularization of chronic total occlusions of the lower extremity. The technical success rate was 84{\%} and predicted by age, renal function, and lesion characteristics. Clinical patency at 6 months was 92{\%} and predicted by renal function, lesion characteristics, and run-off.",
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T1 - Safety and Short-term Outcomes following Controlled Blunt Microdissection Revascularization of Symptomatic Arterial Occlusions of the Pelvis and Lower Extremities

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AU - Misra, Sanjay

AU - Sanikommu, Srinivas R.

AU - Schainfeld, Robert M.

AU - Soukas, Peter A.

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N2 - Purpose: To present the safety and short-term outcomes of using controlled blunt microdissection catheter-assisted revascularization of symptomatic chronic total occlusions of the lower extremity. Materials and Methods: A retrospective study was performed on 61 patients (46 men) with a mean age of 72.3 years ± 9.4 who underwent 67 procedures in 86 arteries between June 2003 and March 2007 for claudication (38 procedures, 57%), rest pain (19 procedures, 28%), and tissue loss (10 procedures, 15%). Technical success was defined as successful traversal of the occlusion. Duplex ultrasonography (US) was used to assess patency. Clinical patency was defined as at least one category improvement in Rutherford score from baseline and absence of target limb revascularization or major amputation at 6 months. Results: Chronic total occlusions were located in aortoiliac (11 arteries, 13%), infrainguinal (72 arteries, 83%), and infrapopliteal (four arteries, 5%) arteries. The mean lesion length was 14.2 cm ± 8. The tibial run-off vessels was 1.9 vessels ± 0.8. The technical success rate of the procedure was 84%. Advanced age (P = .04), renal function (P = .02), and target lesion length (P ≤ .01) were predictors of technical failure. The clinical success rate at 6 months was 92%, and the primary patency with duplex US was 87%. Renal function (P ≤ .01), length of the occlusion (P ≤.01), number of stents per procedure (P ≤.01), and tibial run-off vessels (P = .05) were the predictors of clinical success. Conclusions: The controlled blunt microdissection catheter is safe in the revascularization of chronic total occlusions of the lower extremity. The technical success rate was 84% and predicted by age, renal function, and lesion characteristics. Clinical patency at 6 months was 92% and predicted by renal function, lesion characteristics, and run-off.

AB - Purpose: To present the safety and short-term outcomes of using controlled blunt microdissection catheter-assisted revascularization of symptomatic chronic total occlusions of the lower extremity. Materials and Methods: A retrospective study was performed on 61 patients (46 men) with a mean age of 72.3 years ± 9.4 who underwent 67 procedures in 86 arteries between June 2003 and March 2007 for claudication (38 procedures, 57%), rest pain (19 procedures, 28%), and tissue loss (10 procedures, 15%). Technical success was defined as successful traversal of the occlusion. Duplex ultrasonography (US) was used to assess patency. Clinical patency was defined as at least one category improvement in Rutherford score from baseline and absence of target limb revascularization or major amputation at 6 months. Results: Chronic total occlusions were located in aortoiliac (11 arteries, 13%), infrainguinal (72 arteries, 83%), and infrapopliteal (four arteries, 5%) arteries. The mean lesion length was 14.2 cm ± 8. The tibial run-off vessels was 1.9 vessels ± 0.8. The technical success rate of the procedure was 84%. Advanced age (P = .04), renal function (P = .02), and target lesion length (P ≤ .01) were predictors of technical failure. The clinical success rate at 6 months was 92%, and the primary patency with duplex US was 87%. Renal function (P ≤ .01), length of the occlusion (P ≤.01), number of stents per procedure (P ≤.01), and tibial run-off vessels (P = .05) were the predictors of clinical success. Conclusions: The controlled blunt microdissection catheter is safe in the revascularization of chronic total occlusions of the lower extremity. The technical success rate was 84% and predicted by age, renal function, and lesion characteristics. Clinical patency at 6 months was 92% and predicted by renal function, lesion characteristics, and run-off.

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