OUTBACK catheter for treatment of superficial femoral and iliac artery chronic total occlusion: Experience from two centers.

PURPOSE: The OUTBACK(®) catheter is a reentry device that enables reentry into a vessel lumen from the subintimal space during subintimal angioplasty. It is reserved for cases where reentry has not been possible using conventional wire and catheter techniques. We report a two-center experience in recanalization of the chronic total occlusions of the common iliac (CIA) and the superficial femoral artery (SFA) using the OUTBACK(®) catheter in cases where other techniques were unsuccessful. MATERIAL AND METHODS: All cases where recanalization was performed using the OUTBACK(®) reentry catheter between January 2010 to January 2015 were retrospectively identified and included in this study. 21 patients were identified. The indication for intervention in these cases included claudication and critical leg ischemia. In all cases, conventional recanalization could not be successfully achieved. RESULTS: The OUTBACK(®) catheter was used to recanalize 10 SFA occlusion and 9 CIA occlusions. In 19 patients (90%), reentry into true arterial lumen was successfully achieved. 17 patients had their recanalization through the transfemoral approach whereas 2 patients had a transpopliteal artery approach. In 2 patients, reentry into the true lumen could not be achieved using the OUTBACK(®) catheter due to patient's intolerability for the procedure and severe atherosclerotic calcified plaques. There was 100% patency of the vessel intervened on Duplex ultrasound at 24 months of follow up. 16 patients (84%) remained asymptomatic and 2 patients (10.5%) reported worsening of their symptoms due to the development of new lesions within the arterial system. CONCLUSION: The OUTBACK(®) catheter is an effective and safe technique for reentry into the vessel lumen when conventional techniques fail.

Subintimal recanalisation and stenting of a common iliac artery occlusion by a left axillary and an ipsilateral femoral retrograde approach using modified gooseneck grab aided by balloon dilatation of "dissection port".

The technique of recanalisation using deliberate subintimal dissection of an occluded iliac artery is being increasingly used and practised via ipsilateral and or contralateral approaches. There remains, however, a fair proportion of cases where, in spite of using gooseneck snares, the wire manipulation to traverse the occlusion can prove unsuccessful resulting in failed de-obliteration of the occlusion. We describe a technique to aid successful re-establishment of the patency using balloon dilatation of the dissection "entry port" with modified gooseneck snare grab.

Massive arterial bleeding from a single rectal vessel.

We report a case of massive rectal haemorrhage arising from a single ectatic arterial vessel above the haemorrhoidal cushion in normal rectal mucosa. Use of an anal retractor enable identification of the bleeding vessel and avoided a major laparatomy.