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Special Tools to Treat Difficult Peripheral Arterial Chronic Total Occlusions-Review

Paulo Eduardo Ocke Reis1 and Irlandia Figueira Ocke Reis

The current treatment of lower limb ischemia involves aggressive interventions in order to save the compromised limb and the patient’s life. The risk factors for peripheral arterial occlusive disease are essentially the same as those for atherosclerosis. Ischemic limb has a negative impact on the cardiovascular system and has been associated with increased mortality in patients with arterial occlusive disease. Atherosclerotic lesions with chronic total occlusion in the peripheral arteries are a difficult subset to treat by open or endovascular approaches. Improvements in revascularization techniques have produced more efficient results, in this situation, a minimally invasive endovascular intervention is a more attractive option compared to conventional open procedures, because it is associated with reduced surgical trauma. Now a days we`ve had new endovascular techniques, tactics and surgical materials to contribute to the technical development and improvement of our results for treatment of peripheral arterial disease. Total atherosclerotic arterial occlusions may be a limiting factor for endovascular treatment because of the difficulty in crossing the lesions with conventional guide wires and catheters. Achieving true lumen after subintimal crossing can be challenging and specialized catheters can be used to re-enter the true lumen. In this article, we provide a review of specific devices frontrunner and outback that may increase the procedural success of treating peripheral arterial total occlusions.