3:00 PM Abstract No. 42 Analysis of microchannel recanalization with orbital atherectomy in failed standard recanalization of TASC-II D aortoiliac occlusive disease

Purpose: Endovascular treatment of TASC II D aorto-iliac lesions now an accepted form of revascularization. We sought to analyze the technical and clinical outcomes of microchannel recanalization and orbital atherectomy (MCOA) in TASC II D aorto-iliac lesions refractory to standard recanalization techniques. Materials: Nineteen patients from 2016-2018 with symptomatic TASC-II D aortoiliac occlusive disease (AIOD) prohibitive for open bypass underwent traditional or MCOA recanalization. In four patients, native microchannels were probed and traversed with a 0.014 wire. The atherectomy crown was tracked over wire and orbital atherectomy was initiated with the 1.25 crown starting at the lowest revolution and continued until the microchannel is sufficiently large to track a 1.2 mm balloon for angioplasty. Serial microchannel angioplasty with exchange for stiffer and/or larger profile wires and balloons was achieved until a covered stent could be safely deployed across the target lesion. Technical and clinical outcomes including lesion characteristics, survival, limb salvage, patency, and change in clinical symptoms were analyzed. Results: Both groups had similar Rutherford scores, ABI, and presence of outflow lesions. All MCOA patients presented with long segment unilateral CIA occlusion with contralateral CIA stenosis. In MCOA cases, there were no intraoperative ruptures or dissections. There were many similar metrics and outcomes between traditional recanalization versus MOCA: procedure time (150.3 min vs. 183.0 min, P = 0.41), primary patency rate (86.7% vs. 75.0%, P = 0.53), long-term (2.5 years) clinical symptoms improvement (86.7% vs. 75.0%, P = 0.53), and median all outcome progression free survival (1919 days vs. 1928 days, P = 0.62). Short-term (30 day) clinical symptoms improvement and limb salvage rate was equal between traditional recanalization versus MCOA (100% vs. 100%, P = >0.999). Conclusions: Native microchannel recanalization with subsequent orbital atherectomy is an option in high-risk patients with TASC II D aorto-iliac disease who have failed traditional prodding recanalization. Further work in proper patient selection and safe utilization of atherectomy devices in the CIA is needed.