Chronic total occlusions in peripheral vasculature: techniques and devices

Abstract

Peripheral artery disease continues to increase in an ever-aging society and consumes a significant part of health resources. Chronic total occlusions account for a significant portion of the lesions encountered by endovascular interventionalists. Unlike the coronary circulation, these occlusions are often long and associated with other features of complexity. The two primary issues concerning these lesions are the ability to safely achieve intimal angiographic success and the long-term durability of therapy. Traditionally, the use of percutaneous techniques was limited to certain anatomic subsets, such as stenosis or total occlusions. However, recent advances in wire technology, re-entry catheters, alternative crossing tools and atherectomy devices have increased the interventional armamentarium for this challenging disease subset. This article will focus on some of the techniques in crossing chronic total occlusions lesions, as well as the available devices to improve long-term patency.

Keywords::

• chronic total occlusion
• percutaneous
• peripheral artery disease

Acknowledgement

The authors wish to thank Peggy Layman for manuscript project coordination, review and revisions.

Financial & competing interests disclosure

Richard Heuser holds a hot tip catheter patent and receives honoraria from Spectranetics. He also has minor stock ownership in CSI.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.