الفهرس 
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Abstract
Summary
SFA disease is the most common cause of symptomatic PAD. The inability to cross a CTO is the primary reason for revascularization failure and is associated with a higher risk of complications. Creating an algorithm to maximize the likelihood of successful CTO crossing may help increase overall procedural success rates for complex endovascular procedures and ultimately improve patient outcomes. Thus, we aimed to evaluate the safety and efficacy of different strategies for crossing chronic total occlusion of SFA.
The current prospective study included 30 patients with superficial femoral artery chronic total occlusion or atherosclerosis. Patients were recruited Beni-Suef and 6th of October University Hospitals.
In the present study, we found that the mean age of the included patients was 57.86 ±9.6 years old and the majority of patients were males (56.7%). 76.7% of the patients were smokers. In the present study, the majority of patients were diabetic (80%), hypertensive (70%), and dyslipidemia (63.3%). In addition, 23.3% of the patients had history of IHD.
In the present study, the most common complaints were rest pain, incapacitating claudication and infection (20% each), followed by unhealed ulcer (16.67%) then dry gangrene (13.3%). The rest have combined complaints in form of rest pain with infection (3.3%), incapacitating claudication with gangrene (3.3%) and rest pain with gangrene (3.3%).
In the present study, the antegrade approach was utilized in 70% of the patients. It was observed that the antegrade approach was associated with female gender and less likelihood of previous interventions. The success rate of antegrade approach was approximately 70%. In patients underwent antegrade approach, the most common complications were dissection and perforation.
In five patients who failed antegrade approach, the retrograde approach was utilized. One patient crossed with retrograde access only. Two patients needed SAFARI technique to complete revascularization. In the rest two patient, reentry was difficult either from antegrade or retrograde alone, so, rendezvouses technique done to help wire reentry into true lumen.
In our study, we found that the most common type was C-TOP II (33.3%), followed by type IV (30%), and III (20%).
The present study has a number of limitations. The sample size of our study was relatively small which may affect the generalizability of our findings. Moreover, long-term patient centered outcomes were not utilized in our study. The CTO cap analysis was entirely based on angiographic and duplex morphology, and CTOP types were not adjudicated by an independent core laboratory. This analysis did not take into account plaque composition; the presence, number, and quality of collaterals; or the potential presence of other CTO caps located within the hibernating lumen between the visualized proximal and distal caps.