Reentry Catheter Assisted Subintimal Arterial Flossing with Antegrade-Retrograde Intervention (SAFARI) for Infra-Popliteal Arterial Revascularization

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Ashley M. Barry, MS (she/her/hers)

Medical Student
Rush University Medical Center

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Timothy J. Breider, BS

Medical Student
Rush University Medical Center
DT

David Tabriz, MD, RPVI

Assistant Professor of Radiology
Rush University
SM

Sreekumar Madassery, MD

Associate Professor, Vascular and Interventional Service Line
Rush University Medical Center
Jordan Tasse, MD

Associate Professor, Vascular and Interventional Radiology
Rush University Medical Center
UT

Ulku C. Turba, MD FSIR

Professor, Vascular and Interventional Radiology
RUSH University Medical Center
Bulent Arslan, MD FSIR

Professor and Chair, Vascular and Interventional Service Line
Rush University Medical Center

Disclosure(s):

Ashley M. Barry, MS: No financial relationships to disclose

Jordan Tasse, MD: No financial relationships to disclose

Ulku C. Turba, MD FSIR: No financial relationships to disclose

Bulent Arslan, MD FSIR: Angiodynamics Inc: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); BD Bard: Consultant (Ongoing), Speaking and Teaching (Ongoing); Blackswan Vascular Inc: Consultant (Ongoing), Ownership Interest (Ongoing), Speaking and Teaching (Ongoing); Cook Inc: Consultant (Ongoing), Speaking and Teaching (Ongoing); Medtronic Inc: Consultant (Ongoing), Speaking and Teaching (Ongoing); Penumbra: Speaking and Teaching (Ongoing)

Purpose: To report the technical results and clinical outcomes of re-entry device assisted safari procedure for infra-popliteal recanalization, when conventional safari technique fails to connect antegrade-retrograde accesses.

Materials and Methods: A retrospective electronic medical chart review on patients with CLI who underwent a SAFARI procedure that utilized a reentry device (Outback Elite, Cordis; Hialeah, Florida) between 2013 and 2022 was performed at our institution. Data collected included demographics, comorbidities, technical success, complications within 30 days, and rates of limb loss within 1 year. Patients in which the reentry device was used for deep venous arterialization and/or at sites involving popliteal or more proximal arteries were excluded.

Results:

Twenty-two patients met inclusion criteria (M=15, F=7). Of these, 11 (50.0%) completed at least 1 year of follow-up, 19 (86.4%) completed at least 30 days of follow-up, and 3 (13.6%) were lost to follow-up before 30 days. One patient died within 30 days of the procedure and one additional patient died after 4 months. Infra-popliteal arteries that were targeted with the re-entry device included anterior tibial artery (n=14), posterior tibial artery (n=2), and peroneal artery (n=5), and tibio-peroneal trunk (n=1). The rate of technical success was 95.5% (n=21). The single case of technical failure of the overall procedure was due to inability to advance a balloon through the occlusive segments despite establishing the flossing in antegrade-retrograde approach, after successful use of re-entry device. There were no device related complications in any of the procedures.

Of those that followed up for at least 30 days, the rate of unplanned re-hospitalization within 30 days of discharge from the initial hospitalization was 63.2% (n=12). The indications for re-hospitalization included wound evaluation/foot pain (n=7), chest pain with shortness of breath (n=2), gastrointestinal bleeding (n=1), cardiac arrhythmia (n=1), and hip dislocation (n=1). Of those that followed up for at least 1 year, the rate of lower limb salvage was 72.7% (n=8).

Conclusion: Adjunctive use of re-entry catheter during SAFARI procedures is associated with higher recanalization rates. In our small patient group, this appears to be safe and effective in limb salvage, considering conventional SAFARI techniques failed in this patient group.