Chronic total occlusions in the superficial femoral artery: a novel strategy using a 1.5 mm J-tip hydrophilic guidewire with an over-the-wire balloon catheter under ultrasound guidance.

Chronic total occlusions in the superficial femoral artery (SFA) are the longest and straightest lesions in the whole body. This presents additional technical challenges and the inability to cross the occluded lesion is a common cause of procedural failure in these percutaneous interventions. The objective of this study was to investigate the usefulness of a strategy using a hydrophilic 1.5 mm J-tip 0.035'' guidewire with an over-the-wire balloon catheter under ultrasound guidance for chronic total occlusions in the SFA. This strategy was performed in 32 consecutive patients (36 limbs). Average occlusion length was 17 +/- 10 cm (3-40 cm). The crossover approach was performed in 26 cases (72%); in the remaining 10 cases, the antegrade ipsilateral approach was selected. The technical success rate was 92% (32/36). A secondary popliteal artery approach was performed in the three failed limbs and was successful in two limbs, increasing the final technical success rate to 97%. This novel procedure may be considered the preferred strategy for intervening in chronic total occlusions in the SFA. Copyright 2005 Wiley-Liss, Inc