Usefulness of ultrasound-guided intraluminal approach for long occlusive femoropopliteal lesion
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ORIGINAL ARTICLE
Usefulness of ultrasound‑guided intraluminal approach for long occlusive femoropopliteal lesion Shinsuke Mori1 · Keisuke Hirano1 · Masahiro Yamawaki1 · Norihiro Kobayashi1 · Yasunari Sakamoto1 · Masakazu Tsutsumi1 · Yohsuke Honda1 · Kenji Makino1 · Shigemitsu Shirai1 · Yoshiaki Ito1 Received: 22 June 2020 / Accepted: 28 August 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract To investigate the usefulness of ultrasound-guided (USG) intraluminal approach for femoropopliteal (FP) lesion. 64 patients (73 limbs) with de novo long occlusive (> 15 cm) FP lesions underwent USG intralumial approach from April 2012 to October 2016. Periprocedural intravascular ultrasound findings were collected. Clinical outcome and predictors of restenosis after USG intraluminal approach for de novo long occlusive FP lesion were investigated. Among the study participants, 34% were female, 50% had diabetes mellitus, and 10% received hemodialysis. Lesion and chronic total occlusion (CTO) lengths were 222 ± 55 mm and 201 ± 55 mm, respectively. Procedural success was achieved in 72 lesions (99%). Distal puncture was performed in 7 limbs (10%). The proportion of within-CTO intraplaque, subintimal, and medial routes were 87 ± 21%, 9 ± 15%, and 4 ± 11%, respectively. Primary patency was 71% and 69% at 1 and 2 years. Multivariate analysis revealed that within-CTO intraplaque route proportion [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.67–0.98, p = 0.0339] and lesion length (HR 1.11; CI 1.00–1.22; p = 0.0447) were independent predictors of restenosis.USG intraluminal approach facilitated acquisition of within-CTO intraplaque route in long occlusive FP lesions and could improve clinical outcome. Keywords Superficial femoral artery · Intravascular ultrasound · Endovascular therapy · Chronic total occlusion
Introduction Revascularization of chronic total occlusion (CTO) in femoropopliteal (FP) lesions remains technically challenging due to difficulties encountered during guidewire passage and its high complication rate. Technical success depends on the characteristics of the lesion, as well as operator skills and experience. Passage of the guidewire may be difficult as it may not be possible to obtain a sufficient view of the CTO lesion using angiography. Meanwhile, the maneuver under ultrasound guidance was in various parts of the body and situations, such as puncture, device deployment, drug injection, aspiration, and biopsy [1–4]. Safety of the procedure is ensured by acquiring information of the former part of the device using ultrasound.
Kawarada et al. have already reported about the usefulness of a strategy using a hydrophilic 1.5 mm J-tip 0.035inch guidewire with an over-the-wire balloon catheter under ultrasound guidance for CTO in superficial femoral artery [5]. The strategy is, as it were, ultrasound-guided (USG) subintimal approach. In general, it is difficult to control a 0.035-inch guidewire into the intraplaque route intentionally in subintimal approach [6, 7]. On the other hand, in the
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