Transpedal versus Dual Transpedal –

Transradial Access Approach for

Endovascular Intervention of

Femoropopliteal Artery Chronic Total

Occlusion

Apurva Patel,MD; Wah Wah Htun, MD; Roosha Parikh, MD; Justin Ratcliffe,

MD; Joseph A. Puma, DO; Tak W. Kwan, MD

Disclosure Information

Wah Wah Htun and co-authors

FINANCIAL DISCLOSURES:

None

UNLABELED/UNAPPROVED USES

DISCLOSURE:

None

• ~ 50% PAD = CTO

• Emerging Pedal (TP)/Radial (TR)

access

- Improved technique and

equipment

- Patient comfort, vascular

complication

- Paucity of outcomes

Study Design-Methods

• Prospective Study

• Endovascular intervention of FP CTO for

symptomatic PAD

• Primary pedal (TP) or dual pedal-radial (TP-TR)

approach

• January 2017 to July 2017

• Mean follow up – 3 months (censor – 7/31/17)

• As-treated analysis

Pedal vs Dual Pedal-Radial – FP CTO

• Outcomes

- Crossing success rate

- Procedural success rate

• Primary endpoint

- 3 month major adverse event (death, TVR,

amputation)

• Secondary endpoint

- Access site complication/patency at 30 days

Outcomes

Baseline Characteristics N = 68 patients

Age (years) 77.2 ± 10.1

Male, % 63.2 (43)

H/o Hypertension, % 88.2 (60)

H/o Hyperlipidemia, % 83.8 (57)

H/o Tobacco use, % 67.6 (46)

H/o Coronary artery disease, % 77.9 (53)

H/o Cerebrovascular accident, % 5.9 (4)

H/o Diabetes mellitus, % 58.8 (40)

H/o Prior PVD intervention, % 51.5 (35)

Rutherford classification, %

III - VI 100 (68)

Results

Results

Lesion Characteristics

TP

(Wire + Catheter)

(N=55)

Dual TR-TP

(CART*/Re-entry

Device**)

(N=29)

P-value

Location – FP CTO, % 0.45

SFA 56.4 (31) 48.3 (14)

Popliteal 21.8 (12) 17.2 (5)

SFA-Popliteal 21.8 (12) 34.5 (10)

Ostial SFA involvement, % 20.0 (11) 24.1 (7) 0.78

SFA ISR, % 14.5 (8) 3.4 (1) 0.15

CTO length, % 0.34

> 200mm 56.4 (31) 69.0 (20)

< 200mm 43.6 (24) 31.0 (9)

FP: Femoropopliteal; CTO: chronic total occlusion; ISR: in-stent restenosis;

CART: Controlled antegrade and retrograde tracking

**Outback® LTD® Re-Entry Device

Results TP

(Wire +

Catheter)

(N=55)

Dual TR-TP

(CART/Re-entry

Device*)

(N=29)

P-value

Procedural Details

Total contrast (ml) 42.9 ± 9.6 49.7 ± 8.9 0.002

Fluoroscopy time (sec) 1222.1 ± 964.2 2091.4 ± 884.0 <0.001

Radiation dose (mGy) 129.0 ± 119.5 235.3 ± 103.3 <0.001

Interventional Details

Atherectomy + PTA, % 100.0 (55) 100 (29) --

DCB PTA, % 5.5 (3) 3.5 (1) 0.68

Stent, % 11.0 (6) 3.5 (1) 0.44

Concomitant tibial artery (outflow

disease) PTA, %92.7 (51) 96.6 (28) 0.71

PTA: Percutaneous transluminal angioplasty; DCB: Drug coated balloon;

CART: Controlled antegrade and retrograde tracking

**Outback® LTD® Re-Entry Device

TP (Wire + Catheter)

Dual TP-TR

(CART/Re-entry

Device**)

P-value

Primary endpoint

Clinical events – 3 months, % 0 0 -

Death, % 0 0

Amputation, % 0 0

TVR, % 2.0 (1) 10.3 (3) 0.1

Secondary endpoint

Access site complications at

30 days, %0 0

Access site patency at 30

days, %100 100

Results

TVR: Target vessel revascularization; CART: Controlled antegrade and retrograde tracking

*Mean follow up of 3 months

**Outback® LTD® Re-Entry Device

Figure:Crossing and Procedural Success Rates

for Primary Transpedal (TP) versus Dual TP-

Transradial (TR) (CART/Re-entry* device)

Approach for Treatment of Femoropopliteal (FP)

Chronic Total cclusion (CTO), p=0.006.

CART: Controlled antegrade and retrograde

tracking, *Outback® LTD® Re-Entry Device

Results

Limitations

• Single center

- Generalizability

• Learning curve

• FP-CTO intervention is feasible and safe using TP, dual

TP-TR

- Early ambulation/discharge

- Better QOL

- Less vascular complications

- Avoid femoral access

Conclusion

Thank you#RadialFirst

@kwancardio

@patelapurva