Limitations of the Outback LTD re-entry device in femoropopliteal chronic total occlusions Susanna H. Shin, MD, Donald Baril, MD, Rabih Chaer, MD, Robert.

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Limitations of the Outback LTD re-entry device in femoropopliteal chronic total occlusions Susanna H. Shin, MD, Donald Baril, MD, Rabih Chaer, MD, Robert Rhee, MD, Michel Makaroun, MD, Luke Marone, MD Journal of Vascular Surgery Volume 53, Issue 5, Pages 1260-1264 (May 2011) DOI: 10.1016/j.jvs.2010.10.127 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 Calcification scoring system. Journal of Vascular Surgery 2011 53, 1260-1264DOI: (10.1016/j.jvs.2010.10.127) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2 When Outback LTD re-entry catheter was considered for use, the crossing catheter was left in the subintimal space and the 0.035-inch hydrophilic wire was exchanged for a 0.014-inch Spartacore guidewire (Guidant, Temecula, Calif) and placed over the Spartacore wire. Using fluoroscopy and road map imaging, the Outback catheter is oriented with the needle positioned toward the lumen distal to the occlusion. This involves imaging at 2 separate angles. Initially, the catheter is located parallel to the vessel with the radiopaque marker oriented as an “L” toward the lumen. The image intensifier is then rotated 90 degrees orthogonally and the radiopaque marker is simultaneously oriented as a “T” over the center of the flow lumen. The needle is then deployed and the guidewire advanced through the needle. The Outback catheter is then removed and angioplasty performed with self-expanding stents placed when residual stenosis was > 30% or flow-limiting dissection was identified. Journal of Vascular Surgery 2011 53, 1260-1264DOI: (10.1016/j.jvs.2010.10.127) Copyright © 2011 Society for Vascular Surgery Terms and Conditions