A Percutaneous Crossing Algorithm for Femoropopliteal and Tibial Artery Chronic Total Occlusions (PCTO Algorithm)

Subhash Banerjee, Mehdi H. Shishehbor, Jihad A. Mustapha, Ehrin J. Armstrong, Mohammad Ansari, John H. Rundback, Bryan Fisher, Constantino S. Peña, Emmanouil S Brilakis, Arthur C. Lee, Sahil Parikh

Research output: Contribution to journalArticle

Abstract

Peripheral artery chronic total occlusions (PCTOs) are frequently encountered during endovascular treatment of peripheral artery disease. Failure to successfully cross PCTOs accounts for the majority of unsuccessful endovascular procedures and associated complications. This review outlines a contemporary ultrasound-based approach to crossing femoropopliteal (FP) PCTOs based on a review of prospectively collected case report surveys, published evidence, and expert opinion compiled by the writing group members. The authors describe optimal imaging of PCTO lesions as well as key angiographic and ultrasound imaging features for determining the choice of antegrade, retrograde, or hybrid techniques, initial guidewire selection, guidewire escalation, and dissection re-entry approaches. These concepts are illustrated using clearly defined hierarchical steps and case examples. The writing group members recognize that while the algorithm provided may not encompass all clinical situations, it will serve as a foundation for establishing a systematic procedural strategy for crossing PCTOs to maximize crossing efficiency, treatment success, and patient safety.

Original languageEnglish (US)
Pages (from-to)111-119
Number of pages9
JournalThe Journal of invasive cardiology
Volume31
Issue number4
StatePublished - Apr 1 2019

Fingerprint

Tibial Arteries
Arteries
Endovascular Procedures
Peripheral Arterial Disease
Expert Testimony
Patient Safety
Dissection
Ultrasonography

Keywords

  • chronic total occlusion
  • peripheral artery disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Banerjee, S., Shishehbor, M. H., Mustapha, J. A., Armstrong, E. J., Ansari, M., Rundback, J. H., ... Parikh, S. (2019). A Percutaneous Crossing Algorithm for Femoropopliteal and Tibial Artery Chronic Total Occlusions (PCTO Algorithm). The Journal of invasive cardiology, 31(4), 111-119.

A Percutaneous Crossing Algorithm for Femoropopliteal and Tibial Artery Chronic Total Occlusions (PCTO Algorithm). / Banerjee, Subhash; Shishehbor, Mehdi H.; Mustapha, Jihad A.; Armstrong, Ehrin J.; Ansari, Mohammad; Rundback, John H.; Fisher, Bryan; Peña, Constantino S.; Brilakis, Emmanouil S; Lee, Arthur C.; Parikh, Sahil.

In: The Journal of invasive cardiology, Vol. 31, No. 4, 01.04.2019, p. 111-119.

Research output: Contribution to journalArticle

Banerjee, S, Shishehbor, MH, Mustapha, JA, Armstrong, EJ, Ansari, M, Rundback, JH, Fisher, B, Peña, CS, Brilakis, ES, Lee, AC & Parikh, S 2019, 'A Percutaneous Crossing Algorithm for Femoropopliteal and Tibial Artery Chronic Total Occlusions (PCTO Algorithm)', The Journal of invasive cardiology, vol. 31, no. 4, pp. 111-119.
Banerjee, Subhash ; Shishehbor, Mehdi H. ; Mustapha, Jihad A. ; Armstrong, Ehrin J. ; Ansari, Mohammad ; Rundback, John H. ; Fisher, Bryan ; Peña, Constantino S. ; Brilakis, Emmanouil S ; Lee, Arthur C. ; Parikh, Sahil. / A Percutaneous Crossing Algorithm for Femoropopliteal and Tibial Artery Chronic Total Occlusions (PCTO Algorithm). In: The Journal of invasive cardiology. 2019 ; Vol. 31, No. 4. pp. 111-119.
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