Percutaneous Revascularization of Peripheral Chronic Total Occlusion — Which Patients, Why, and How?

**Nate** · #1 06-17-2010, 10:51 AM

Percutaneous Revascularization of Peripheral Chronic Total Occlusion — Which Patients, Why, and How?

VOLUME: 4 PUBLICATION DATE: Jul 01 2007

Issue Number:
Volume 4, Issue 4 (July/August 2007)

Aravinda Nanjundappa, MD and
Robert S. Dieter, MD

"Recanalization of peripheral arterial total occlusion in lower extremities plays a pivotal role to improve claudication symptoms and limb salvage. Coronary chronic total occlusion (CTO) recanalization has recently gathered controversy with the publication of the occluded artery trial (OAT). However, in peripheral vasculature, specifically in the superficial femoral artery (SFA), occlusion predominates stenosis. The predominance of occlusion is due to limited collaterals, namely the profunda femoris artery and the diffuse nature of the disease.2 The constant endothelial injury, due to twisting, contraction, and kinking of the arteries, results in accelerated atherosclerosis.
Diagnosis of peripheral arterial occlusive disease (PAOD) is by history and physical examination.3 The site of pain in limbs can localize the location of occlusive disease. For example, SFA occlusion manifests as calf pain. Claudication results in the aching, throbbing, or cramping pain in the feet, calves, thighs, or buttocks during ambulation. The pain occurs after walking the same distance each time. The pain should subside in a few minutes, following the cessation of walking. The severity of claudication is best described by Fontaine classification I to IV, ranging from no pain to ulcer or gangrene. The class II is further subdivided into IIa and IIb for the ability to walk > 200 feet and < 200 feet. Physical examination can localize the site of occlusion easily. An absent popliteal artery pulse denotes SFA occlusive disease, while an absent femoral pulse indicates aorto-iliac occlusion. Treatment is warranted for all classes of PAOD, which includes control of hypertension, diabetes mellitus and hypercholesterolemia, cessation of smoking, antiplatlet therapy, and exercise. Revascularization should be considered for persistent claudication despite medical therapy. Revascularization with optimization of medical treatment is needed for patients with rest pain, ulcer, or gangrene. .."

Click on the link for the full article:
http://vasculardiseasemanagement.com/article/7541

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