PMID- 32127314
OWN - NLM
STAT- MEDLINE
DCOM- 20200928
LR  - 20221207
IS  - 1535-7732 (Electronic)
IS  - 1051-0443 (Linking)
VI  - 31
IP  - 4
DP  - 2020 Apr
TI  - Outcome and Distal Access Patency in Subintimal Arterial Flossing with 
      Antegrade-Retrograde Intervention for Chronic Total Occlusions in Lower Extremity 
      Critical Limb Ischemia.
PG  - 601-606
LID - S1051-0443(19)31033-4 [pii]
LID - 10.1016/j.jvir.2019.12.006 [doi]
AB  - PURPOSE: To report the outcome and distal access patency of the Subintimal 
      Arterial Flossing with Antegrade-Retrograde Intervention (SAFARI) technique for 
      chronic total occlusion (CTO) in critical limb ischemia (CLI). MATERIALS AND 
      METHODS: From January 2009 to June 2015, 220 SAFARI procedures were performed for 
      200 limbs in 191 patients (108 males [56.5%]; median age, 70 years old; range, 36 
      to 97 years old) with CLI (9.4% were Fontaine classification 3; and 90.6% were 
      Fontaine classification 4). Distal access was obtained from the distal 
      superficial femoral artery (n = 6), popliteal artery (n = 49), anterior tibial 
      artery (n = 56), dorsalis pedis (n = 51), peroneal artery (n = 12), posterior 
      tibial artery (n = 45), and lateral plantar artery (n = 1). Distal access 
      hemostasis was obtained with internal balloon tamponade in 71.4% (n = 157). 
      Outcome measurements were technical success, freedom from major amputation and 
      complications. Preprocedural angiograms of clinically driven repeat interventions 
      were reviewed in 73 cases for distal access patency. RESULTS: Technical success 
      was achieved in 80.5% (n = 177). Reasons for technical failure include inability 
      to obtain distal access (n = 3), cross the occlusion retrogradely (n = 16), 
      re-enter the true lumen (n = 9), and achieve antegrade blood flow after the 
      procedure (n = 15). Freedom from major amputation for technically successful 
      procedures was 84.7%, 82.9%, and 81.9% at 6, 12, and 24 months, respectively. 
      There were 3 cases of distal access bleeding with 1case that required coil 
      embolization. The distal access remained patent in 80.8% of observable cases with 
      repeated endovascular intervention. CONCLUSIONS: Distal retrograde arterial 
      access (SAFARI) technique is safe and effective in the treatment of CTOs in the 
      context of CLI, after failure of antegrade revascularization.
CI  - Copyright (c) 2019 SIR. Published by Elsevier Inc. All rights reserved.
FAU - Zhuang, Kun Da
AU  - Zhuang KD
AD  - Department of Vascular and Interventional Radiology, Singapore General Hospital, 
      Singapore. Electronic address: zhuang.kun.da@singhealth.com.sg.
FAU - Patel, Ankur
AU  - Patel A
AD  - Department of Vascular and Interventional Radiology, Singapore General Hospital, 
      Singapore.
FAU - Tan, Bien Soo
AU  - Tan BS
AD  - Department of Vascular and Interventional Radiology, Singapore General Hospital, 
      Singapore.
FAU - Irani, Farah Gillan
AU  - Irani FG
AD  - Department of Vascular and Interventional Radiology, Singapore General Hospital, 
      Singapore.
FAU - Gogna, Apoorva
AU  - Gogna A
AD  - Department of Vascular and Interventional Radiology, Singapore General Hospital, 
      Singapore.
FAU - Chan, Shaun Xavier
AU  - Chan SX
AD  - Department of Vascular and Interventional Radiology, Singapore General Hospital, 
      Singapore.
FAU - Sanamandra, Sarat Kumar
AU  - Sanamandra SK
AD  - Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
FAU - Chong, Tze Tec
AU  - Chong TT
AD  - Department of Vascular Surgery, Singapore General Hospital, Singapore.
FAU - Chng, Siew Ping
AU  - Chng SP
AD  - Department of Vascular Surgery, Singapore General Hospital, Singapore.
FAU - Tay, Kiang Hiong
AU  - Tay KH
AD  - Department of Vascular and Interventional Radiology, Singapore General Hospital, 
      Singapore.
LA  - eng
PT  - Journal Article
DEP - 20200229
PL  - United States
TA  - J Vasc Interv Radiol
JT  - Journal of vascular and interventional radiology : JVIR
JID - 9203369
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Amputation, Surgical
MH  - Chronic Disease
MH  - Critical Illness
MH  - *Endovascular Procedures/adverse effects
MH  - Female
MH  - Humans
MH  - Ischemia/diagnostic imaging/physiopathology/*therapy
MH  - Limb Salvage
MH  - Lower Extremity/*blood supply
MH  - Male
MH  - Middle Aged
MH  - Peripheral Arterial Disease/diagnostic imaging/physiopathology/*therapy
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Vascular Patency
EDAT- 2020/03/05 06:00
MHDA- 2020/09/29 06:00
CRDT- 2020/03/05 06:00
PHST- 2019/08/03 00:00 [received]
PHST- 2019/12/05 00:00 [revised]
PHST- 2019/12/07 00:00 [accepted]
PHST- 2020/03/05 06:00 [pubmed]
PHST- 2020/09/29 06:00 [medline]
PHST- 2020/03/05 06:00 [entrez]
AID - S1051-0443(19)31033-4 [pii]
AID - 10.1016/j.jvir.2019.12.006 [doi]
PST - ppublish
SO  - J Vasc Interv Radiol. 2020 Apr;31(4):601-606. doi: 10.1016/j.jvir.2019.12.006. 
      Epub 2020 Feb 29.