Novel intravascular ultrasound-guided method to create transintimal arterial communications: Initial experience in peripheral occlusive disease and aortic dissection

Ramin R. Saket, Mahmood K. Razavi, Arash Padidar, Stephen T. Kee, Daniel Y. Sze, Michael D. Dake

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Purpose: To report our experience using a commercially available catheter-based system equipped with an intravascular ultrasound (IVUS) transducer to achieve controlled true lumen re-entry in patients undergoing subintimal angioplasty for chronic total occlusions (CTO) or aortic dissections. Methods: During an 8-month period, 10 patients (6 men; mean age 73.4 years) with lower extremity (LE) ischemia from CTOs (n=7) or true lumen collapse from aortic dissections (n=3) were treated. Subintimal access and controlled re-entry of the CTOs were performed with a commercially available 6.2-F dual-lumen catheter, which contained an integrated 64-element phased-array IVUS transducer and a deployable 24-G needle through which a guidewire was passed once the target lumen was reached. The occluded segments were balloon dilated; self-expanding nitinol stents were deployed. In the aortic dissections, fenestrations were performed using the same device, with the IVUS unit acting as the guide. The fenestrations were balloon dilated and stented to support the true lumen. Results: Time to effective re-entry ranged from 6 to 10 minutes (mean 7) in the CTOs; antegrade flow was restored in all 7 CTOs, and the patients were free of ischemic symptoms at up to 8-month follow-up. In the aortic dissection cases, the fenestrations equalized pressures between the lumens and restored flow into the compromised vessels. There were no complications related to the use of this device in any of the 10 patients. Conclusions: Our preliminary results demonstrate the feasibility of using this catheter-based system for subintimal recanalization with controlled re-entry in CTOs and for aortic flap fenestrations in aortic dissections. This approach can improve the technical success rate, reduce the time of the procedure, and minimize potential complications.

Original languageEnglish (US)
Pages (from-to)274-280
Number of pages7
JournalJournal of Endovascular Therapy
Volume11
Issue number3
DOIs
StatePublished - Jun 1 2004
Externally publishedYes

Fingerprint

Aortic Diseases
Dissection
Communication
Catheters
Transducers
Equipment and Supplies
Angioplasty
Needles
Stents
Lower Extremity
Ischemia
Pressure

Keywords

  • Aortic dissection
  • Chronic arterial occlusion
  • Intravascular ultrasound
  • Percutaneous intentional extraluminal recanalization
  • Re-entry
  • Subintimal angioplasty
  • True lumen

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Novel intravascular ultrasound-guided method to create transintimal arterial communications : Initial experience in peripheral occlusive disease and aortic dissection. / Saket, Ramin R.; Razavi, Mahmood K.; Padidar, Arash; Kee, Stephen T.; Sze, Daniel Y.; Dake, Michael D.

In: Journal of Endovascular Therapy, Vol. 11, No. 3, 01.06.2004, p. 274-280.

Research output: Contribution to journalArticle

@article{df11b7e18bd04b2b90bae99b2dbb38ed,
title = "Novel intravascular ultrasound-guided method to create transintimal arterial communications: Initial experience in peripheral occlusive disease and aortic dissection",
abstract = "Purpose: To report our experience using a commercially available catheter-based system equipped with an intravascular ultrasound (IVUS) transducer to achieve controlled true lumen re-entry in patients undergoing subintimal angioplasty for chronic total occlusions (CTO) or aortic dissections. Methods: During an 8-month period, 10 patients (6 men; mean age 73.4 years) with lower extremity (LE) ischemia from CTOs (n=7) or true lumen collapse from aortic dissections (n=3) were treated. Subintimal access and controlled re-entry of the CTOs were performed with a commercially available 6.2-F dual-lumen catheter, which contained an integrated 64-element phased-array IVUS transducer and a deployable 24-G needle through which a guidewire was passed once the target lumen was reached. The occluded segments were balloon dilated; self-expanding nitinol stents were deployed. In the aortic dissections, fenestrations were performed using the same device, with the IVUS unit acting as the guide. The fenestrations were balloon dilated and stented to support the true lumen. Results: Time to effective re-entry ranged from 6 to 10 minutes (mean 7) in the CTOs; antegrade flow was restored in all 7 CTOs, and the patients were free of ischemic symptoms at up to 8-month follow-up. In the aortic dissection cases, the fenestrations equalized pressures between the lumens and restored flow into the compromised vessels. There were no complications related to the use of this device in any of the 10 patients. Conclusions: Our preliminary results demonstrate the feasibility of using this catheter-based system for subintimal recanalization with controlled re-entry in CTOs and for aortic flap fenestrations in aortic dissections. This approach can improve the technical success rate, reduce the time of the procedure, and minimize potential complications.",
keywords = "Aortic dissection, Chronic arterial occlusion, Intravascular ultrasound, Percutaneous intentional extraluminal recanalization, Re-entry, Subintimal angioplasty, True lumen",
author = "Saket, {Ramin R.} and Razavi, {Mahmood K.} and Arash Padidar and Kee, {Stephen T.} and Sze, {Daniel Y.} and Dake, {Michael D.}",
year = "2004",
month = "6",
day = "1",
doi = "10.1583/03-1133.1",
language = "English (US)",
volume = "11",
pages = "274--280",
journal = "Journal of Endovascular Therapy",
issn = "1526-6028",
publisher = "International Society of Endovascular Specialists",
number = "3",

}

TY - JOUR

T1 - Novel intravascular ultrasound-guided method to create transintimal arterial communications

T2 - Initial experience in peripheral occlusive disease and aortic dissection

AU - Saket, Ramin R.

AU - Razavi, Mahmood K.

AU - Padidar, Arash

AU - Kee, Stephen T.

AU - Sze, Daniel Y.

AU - Dake, Michael D.

PY - 2004/6/1

Y1 - 2004/6/1

N2 - Purpose: To report our experience using a commercially available catheter-based system equipped with an intravascular ultrasound (IVUS) transducer to achieve controlled true lumen re-entry in patients undergoing subintimal angioplasty for chronic total occlusions (CTO) or aortic dissections. Methods: During an 8-month period, 10 patients (6 men; mean age 73.4 years) with lower extremity (LE) ischemia from CTOs (n=7) or true lumen collapse from aortic dissections (n=3) were treated. Subintimal access and controlled re-entry of the CTOs were performed with a commercially available 6.2-F dual-lumen catheter, which contained an integrated 64-element phased-array IVUS transducer and a deployable 24-G needle through which a guidewire was passed once the target lumen was reached. The occluded segments were balloon dilated; self-expanding nitinol stents were deployed. In the aortic dissections, fenestrations were performed using the same device, with the IVUS unit acting as the guide. The fenestrations were balloon dilated and stented to support the true lumen. Results: Time to effective re-entry ranged from 6 to 10 minutes (mean 7) in the CTOs; antegrade flow was restored in all 7 CTOs, and the patients were free of ischemic symptoms at up to 8-month follow-up. In the aortic dissection cases, the fenestrations equalized pressures between the lumens and restored flow into the compromised vessels. There were no complications related to the use of this device in any of the 10 patients. Conclusions: Our preliminary results demonstrate the feasibility of using this catheter-based system for subintimal recanalization with controlled re-entry in CTOs and for aortic flap fenestrations in aortic dissections. This approach can improve the technical success rate, reduce the time of the procedure, and minimize potential complications.

AB - Purpose: To report our experience using a commercially available catheter-based system equipped with an intravascular ultrasound (IVUS) transducer to achieve controlled true lumen re-entry in patients undergoing subintimal angioplasty for chronic total occlusions (CTO) or aortic dissections. Methods: During an 8-month period, 10 patients (6 men; mean age 73.4 years) with lower extremity (LE) ischemia from CTOs (n=7) or true lumen collapse from aortic dissections (n=3) were treated. Subintimal access and controlled re-entry of the CTOs were performed with a commercially available 6.2-F dual-lumen catheter, which contained an integrated 64-element phased-array IVUS transducer and a deployable 24-G needle through which a guidewire was passed once the target lumen was reached. The occluded segments were balloon dilated; self-expanding nitinol stents were deployed. In the aortic dissections, fenestrations were performed using the same device, with the IVUS unit acting as the guide. The fenestrations were balloon dilated and stented to support the true lumen. Results: Time to effective re-entry ranged from 6 to 10 minutes (mean 7) in the CTOs; antegrade flow was restored in all 7 CTOs, and the patients were free of ischemic symptoms at up to 8-month follow-up. In the aortic dissection cases, the fenestrations equalized pressures between the lumens and restored flow into the compromised vessels. There were no complications related to the use of this device in any of the 10 patients. Conclusions: Our preliminary results demonstrate the feasibility of using this catheter-based system for subintimal recanalization with controlled re-entry in CTOs and for aortic flap fenestrations in aortic dissections. This approach can improve the technical success rate, reduce the time of the procedure, and minimize potential complications.

KW - Aortic dissection

KW - Chronic arterial occlusion

KW - Intravascular ultrasound

KW - Percutaneous intentional extraluminal recanalization

KW - Re-entry

KW - Subintimal angioplasty

KW - True lumen

UR - http://www.scopus.com/inward/record.url?scp=3042651497&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=3042651497&partnerID=8YFLogxK

U2 - 10.1583/03-1133.1

DO - 10.1583/03-1133.1

M3 - Article

C2 - 15174902

AN - SCOPUS:3042651497

VL - 11

SP - 274

EP - 280

JO - Journal of Endovascular Therapy

JF - Journal of Endovascular Therapy

SN - 1526-6028

IS - 3

ER -