Skip to main content

Advertisement

SpringerLink
Log in

Percutaneous Intraluminal Recanalization of Long, Chronic Superficial Femoral and Popliteal Occlusions Using the Frontrunner XP CTO Device: A Single-Center Experience

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

The purpose of this study was to examine the safety and efficacy of the Frontrunner XP CTO (chronic total occlusion) Catheter (Cordis) for recanalization of long femoropopliteal artery occlusions. A Frontrunner catheter was used to treat 26 CTOs in SFA after guidewire failure (68.3 ± 8.8 years). Sixty-seven percent of patients had severe claudication. Critical lower limb ischemia with rest pain or minor tissue loss was present in three and eight patients, respectively. All the lesions were considered complex (TASC B, C, and D); 68% of the lesions were heavily calcified. The mean lesion length was 17.6 cm (range, 10–42 cm). The initial attempt to cross the occlusion with the CTO guidewire V18 was unsuccessful in 26 of 76 limbs (34.26%). A secondary attempt using the Frontrunner catheter (crossover approach, 27%; antegrade, 73%) performed in all 26 failed cases was successful in 17 limbs (65.38%), increasing the technical success rate to 88.12%. The main reasons for failure with the Frontrunner were inability to cross the lesion due to heavy calcification (six of nine) and inability to re-enter the true lumen after subintimal passage of the occluded segment (three of nine). The mean fluoroscopy time was 22.9 min. Minor complications included one distal extension of the dissection with involvement of the first popliteal segment and one perforation in the occluded segment. No major complications were seen. In conclusion, recanalization with the Frontrunner CTO catheter is a simple and safe method with a high technical success rate in the endovascular treatment of long superficial femoral artery occlusions and should be an alternative method after guidewire failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Inter-Society Consensus for the management of peripheral arterial disease (TASC II) (2007) Eur J Vasc Endovasc Surg 33:1–75

    Google Scholar 

  2. Dormandy JA, Rutherfort RB (2000) Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 31:1–269

    Article  Google Scholar 

  3. TransAtlantic Inter-Society Consensus (TASC) (2000) Management of peripheral arterial disease (PAD). Eur J Vasc Endovasc Surg 19:1–250

    Article  Google Scholar 

  4. Van der Heijden FH, Eikelboom BC, Banga JD et al (1993) Management of superficial femoral artery occlusive disease. Br J Surg 80:959–963

    Article  PubMed  Google Scholar 

  5. Bolia A, Brennan J, Bell PR (1989) Recanalisation of femoro-popliteal occlusions: improving success rate by subintimal recanalisation. Clin Radiol 40:325

    Article  CAS  PubMed  Google Scholar 

  6. Bolia A, Miles KA, Brennan J et al (1990) Percutaneous transluminal angioplasty of occlusions of the femoral and popliteal arteries by subintimal dissection. CardioVasc Interv Radiol 13:357–363

    Article  CAS  Google Scholar 

  7. Ingle H, Nasim A, Bolia A et al (2002) Subintimal angioplasty of isolated infragenicular vessels in lower limb ischemia: long-term results. J Endovasc Ther 9:411–416

    Article  PubMed  Google Scholar 

  8. Lazaris AM, Tsiamis AC, Fishwick G et al (2004) Clinical outcome of primary infrainguinal subintimal angioplasty in diabetic patients with critical lower limb ischemia. J Endovasc Ther 11:447–453

    Article  PubMed  Google Scholar 

  9. Desgranges P, Boufi M, Lapeyre M et al (2004) Subintimal angioplasty: feasible and durable. Eur J Vasc Endovasc Surg 28:138–141

    CAS  PubMed  Google Scholar 

  10. Met R, Van Lienden KP, Koelemay MJ et al (2008) Subintimal angioplasty for peripheral arterial occlusive disease: a systematic review. CardioVasc Interv Radiol. 31:687–697

    Article  Google Scholar 

  11. Laxdal E, Jenssen GL, Pedersen G et al (2003) Subintimal angioplasty as a treatment of femoropopliteal artery occlusions. Eur J Endovasc Surg 25:578–582

    Article  CAS  Google Scholar 

  12. Lipsitz EC, Ohki T, Veith FJ et al (2003) Does subintimal angioplasty have a role in the treatment of severe lower extremity ischemia? J Vasc Surg 37:386–391

    Article  PubMed  Google Scholar 

  13. Loftus IM, Hayes PD, Bell PRF (2004) Subintimal angioplasty in lower limb ischemia. J Cardiovasc Surg 45:217–229

    CAS  Google Scholar 

  14. Yilmaz S, Sindel T, Yegin A et al (2003) Subintimal angioplasty of long superficial femoral artery occlusions. J Vasc Interv Radiol 14:997–1010

    PubMed  Google Scholar 

  15. London NJ, Srinivasan R, Naylor AR et al (1994) Subintimal angioplasty of femoropopliteal artery occlusions: the long-term results. Eur J Vasc Surg 8:148–155

    Article  CAS  PubMed  Google Scholar 

  16. Ramaiah V, Gammon R, Kiesz S et al (2006) Midterm outcomes from the TALON Registry: treating peripherals with SilverHawk: outcomes collection. J Endovasc Ther 13(5):592–602

    Article  PubMed  Google Scholar 

  17. Jahnke T et al (2001) Rotational atherectomy for BTK disease. J Vasc Interv Radiol 12:221–226

    Article  CAS  PubMed  Google Scholar 

  18. Scheinert D, Laird JR, Schroder M et al (2001) Excimer laser-assisted recanalization of long, chronic superficial femoral artery occlusions. J Endovasc Ther 8:156–166

    Article  CAS  PubMed  Google Scholar 

  19. Zeller T, Rastan A, Schwarzwalder U et al (2004) percutaneous peripheral atherectomy of femoropopliteal stenoses using a new-generation device: six-month results from a single-center experience. J Endovasc Ther 11:676–685

    Article  PubMed  Google Scholar 

  20. Steinkamp HJ, Wissgott C, Rademaker J et al (2002) Short (1–10 cm) superficial femoral artery occlusions: results of treatment with excimer laser angioplasty. CardioVasc Interv Radiol 25:388–396

    Article  CAS  Google Scholar 

  21. Laird JR, Zeller T, Gray BH et al (2006) Limb salvage following laser-assisted angioplasty for critical limb ischemia: results of the LACI multicenter trial. J Endovasc Ther 13(1):1–11

    Article  PubMed  Google Scholar 

  22. Mossop P, Cincotta M, Whitbourn R et al (2003) First case reports of controlled blunt microdissection for percutaneous transluminal angioplasty of chronic total occlusions in peripheral arteries. Catheter Cardiovasc Interv 59:255

    Article  PubMed  Google Scholar 

  23. Roukoz B, Haider AH, Surabhi S et al (2003) Initial experience with the Lumend Frontrunner Catheter for treatment of chronic superficial femoral artery occlusion. J Cardiol 92:158L

    Google Scholar 

  24. Selmon M (2003) Blunt microdissection of chronic total occlusion. Endovasc Today 10:38–40

    Google Scholar 

  25. Rutherford RB (1991) Standards for evaluating results of interventional therapy for peripheral vascular disease. Circulation 83(Suppl I):I-6–I-11

    CAS  Google Scholar 

  26. Dalman RL, Taylor LM (1990) Basic data related to infrainguinal revascularization procedures. Ann Vasc Surg 4:309–312

    Article  CAS  PubMed  Google Scholar 

  27. Jahnke T, Andresen R, Muller-Hulsbeck S et al (2003) Hemobahn stent-grafts for treatment of femoropoplitea arterial obstructions: midterm results of a prospective trial. J Vasc Interv Radiol 14:41–51

    PubMed  Google Scholar 

  28. Saxon RR, Coffman JM, Gooding JM et al (2003) Long-term results of ePTFE stent-graft versus angioplasty in the femoropopliteal artery: single center experience from a prospective, randomizedtrial. J Vasc Interv Radiol 14:303–311

    PubMed  Google Scholar 

  29. Deutschmann HA, Schedlbauer P, Berczi V et al (2001) Placement of Hemobahn stent-grafts in femoropopliteal arteries: early experience and midterm results in 18 patients. J Vasc Interv Radiol 12:943–950

    Article  CAS  PubMed  Google Scholar 

  30. Duda SH, Bosiers M, Lammer J et al (2005) Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the SIROCCO II trial. J Vasc Interv Radiol 16:331–338

    PubMed  Google Scholar 

  31. Mewissen MW (2004) Self-expanding nitinol stents in the femoropopliteal segment: technique and mid-term results. Tech Vasc Interv Radiol 7:2–5

    Article  PubMed  Google Scholar 

  32. Schillinger M, Sabeti S, Loewe C et al (2006) Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med 354:1879–1888

    Article  CAS  PubMed  Google Scholar 

  33. Schlager O, Dick P, Sabeti S et al (2005) Long-segment SFA stenting—the dark sides: in-stent restenosis, clinical deterioration, and stent fractures. J. Endovasc Ther 12:676–684

    Article  PubMed  Google Scholar 

  34. Schillinger M, Sabeti S, Dick P et al (2007) Sustained benefit at 2 years of primary femoropopliteal stenting compared with balloon angioplasty with optional stenting. Circulation 115:2745–2749

    Article  PubMed  Google Scholar 

  35. Duda SH, Bosiers M, Lammer J et al (2006) Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial. J Endovasc Ther 13(6):701–710

    Article  PubMed  Google Scholar 

  36. Smith BM, Stechman M, Gibson M et al (2005) Subintimal angioplasty for superficial femoral artery occlusion: poor patency in critical ischaemia. Ann R Coll Surg Engl 87:361–365

    Article  CAS  PubMed  Google Scholar 

  37. Molloy KJ, Nasim A, London NJM et al (2003) Percutaneous transluminal angioplasty in the treatment of critical limb ischemia. J Endovasc Ther 10:298–303

    Article  PubMed  Google Scholar 

  38. Hyne N, Akhtar Y, Manning B et al (2004) Subintimal angioplasty as a primary modality in the management of critical limb ischemia: comparison to bypass grafting for aortoiliac and femoropopliteal occlusive disease. J Endovasc Ther 11:460–471

    Article  Google Scholar 

Download references

Open Access

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold- Heller Strasse 9, 24105, Kiel, Germany

    Nikolas Charalambous, Philipp J. Schäfer, Jens Trentmann, Tim. H. Hümme, Christine Stöhring, Martin Heller & Thomas Jahnke

  2. Department of Radiology, Academic Hospitals Flensburg, Flensburg, Germany

    Stefan Müller-Hülsbeck

Authors
  1. Nikolas Charalambous
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philipp J. Schäfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jens Trentmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tim. H. Hümme
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christine Stöhring
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stefan Müller-Hülsbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Martin Heller
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thomas Jahnke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nikolas Charalambous.

Additional information

All authors have made a direct and substantial contribution to this work. I hereby affirm the originality and each author’s responsibility to the submitted manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Charalambous, N., Schäfer, P.J., Trentmann, J. et al. Percutaneous Intraluminal Recanalization of Long, Chronic Superficial Femoral and Popliteal Occlusions Using the Frontrunner XP CTO Device: A Single-Center Experience. Cardiovasc Intervent Radiol 33, 25–33 (2010). https://doi.org/10.1007/s00270-009-9700-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-009-9700-x

Keywords

Search

Navigation