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Percutaneous revascularization of chronic total occlusions. Tech Vasc Interv Radiol 2010 Mar;13(1):23-36

Date

02/04/2010

Pubmed ID

20123430

DOI

10.1053/j.tvir.2009.10.004

Scopus ID

2-s2.0-72149115639   10 Citations

Abstract

Many patients with severe intermittent claudication (IC) or critical limb ischemia (CLI) have chronic total occlusions (CTO) in their lower extremity vascular bed. The successful treatment of these lesions is becoming increasingly more important as the population ages and the prevalence of diseases such as diabetes mellitus and its consequences increases. Many of these patients have significant comorbidities and may benefit from less invasive treatment options. Several endovascular techniques have now become well established in the treatment of these lesions. Additionally, several new adjunctive tools have been developed to enhance the technical success of CTO revascularization. These tools and techniques offer a minimally invasive alternative for limb salvage in this compromised patient population and have become an established practice in many centers. Although some concerns about procedure durability and lower rates of primary patency exist, particularly when compared to surgical bypass, the limb salvage and amputation-free survival rates are much more encouraging. Advantages of these techniques compared to surgical bypass are reduced morbidity and mortality, reduced anesthesia requirements, and potential reductions in length of hospital stay and cost. In addition, bypass options are typically preserved after endovascular treatment. The more conventional and some newer endovascular treatment approaches, some of the adjunctive tools and techniques used in CTO revascularization as well as their clinical results will be discussed in this review.

Author List

Patel PJ, Hieb RA, Bhat AP

Authors

Robert A. Hieb MD Professor in the Radiology department at Medical College of Wisconsin
Parag J. Patel MD, MS, FSIR Professor in the Radiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Amputation
Angioplasty, Balloon
Arterial Occlusive Diseases
Cardiovascular Agents
Chronic Disease
Constriction, Pathologic
Disease Progression
Equipment Design
Female
Humans
Intermittent Claudication
Ischemia
Limb Salvage
Male
Middle Aged
Radiography, Interventional
Stents
Treatment Outcome
Ultrasonography, Interventional
Vascular Surgical Procedures
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