1. Evaluation of ReeKross balloon catheter in treating iliofemoral artery chronic total occlusions Xinwu Lu Vascular Center of Shanghai Jiaotong University. Department of Vascular Surgery, 9th People ’ s Hospital Affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China

2. Long segment CTO of iliac artery

3. Long segment CTO of SFA

4. PTA: Percutaneous Transluminal Angioplasty PAD: peripheral arterial disease It is a endovascular treatment time now. A large number of PTA procedures has performed for PAD in the last two decades.

5. Difficult: heavy intima and media calcification Passage failureBalloon puncture Result in Long lesions Distal access

6. To assess the technical success and immediate clinical outcomes of ReeKross Balloon Catheter in treating iliofemoral artery CTO lesions Objective:

7. From Oct 2010 to Jan 2011 In 28 patients with CTO in iliofemoral artery, a ReeKross 18 catheter was used as either primary or secondary balloon catheter in a total of 35 arteries. Patient demographic, anatomical, procedural, and technical data were recorded. methods:

8. Access: left brachial artery Intra-operative imaging showed CTO of the left iliac artery 0.018-inch hydrophilic guidewire and 4F catheter was used for recanalization (Berenstein Mariner 4F catheter ) ReeKross balloon catheter was used as treatment catheter when passage was achieved Standard balloon cant not cross target lesion Final angiogram revealed reconstructed left iliac artery after stent was deployed Procedures: Video:

9. Long lesion Heavy calcification Procedures:

10. A 78-year-old man with rest pain. B: DSA revealed a CTO of the right iliac artery. C: DSA showed the catheter located in true lumen. D: DSA revealed the reconstructed right iliac artery after balloon dilatation and stent deployment. Procedures:

11. A 69-year-old man with rest pain. A: DSA revealed a CTO of the left iliac artery. B,C: 3mm ReeKross balloon catheter was used as predilation catheter following with 8mm balloon. D: DSA revealed the left iliac artery recanalization after stent deployment. Procedures:

12. Access: left femoral artery Intra-operative imaging showed CTO of the right SFA 0.018-inch hydrophilic guidewire and 4F catheter was used for recanalization but failured Procedures: Video:

13. Video: Guidewire crossed the lesion when ReeKross balloon catheter used Procedures: Video: DSA revealed the SFA recanalization after balloon dilation and stent deployment

14. A 77-year-old man with CTO of the left SFA (patency of the vein graft). ReeKross balloon catheter was used as primary catheter. DSA revealed the SFA recanalization

15. Patients: 28 patients (11 female, 17 male), 68±11 years old. The ReeKross was used as the primary treatment catheter in 29 occluded lesions the secondary treatment catheter in 6 occluded lesions Results:

16. Primary(29)Secondary(6) Technical success 96.6%(28/29) 100%(6/6) failure(4) rupture(1) Patency rate 100%(6/6)100%(28/28) In 4 arteries, ordinary balloons were unable to follow the guidewire that was successfully advanced across the target lesions. In 1 artery, ordinary balloon was ruptured during balloon dilatation. In 1 artery, original catheter gave an inadequate post-dilatation result. No device-related adverse events. inadequate(1) Results:

17. Discussions: There is now a strong tendency to treat more severe and extensive arterial occlusive disease percutaneously instead of surgically. Lancet. 2005,3:1925–1934 The recanalization failed in approximately 20% of cases. Circulation.2007, 116:2072–2085

18. High calcification, long lesions, distal access (brachial access) and heavy tortuorities may inhibit balloon catheter passage distally after guidewire passage, resulting in treatment failure or balloon rupture. Cardiovasc Intervent Radiol. 2009, 32:132–135 Discussions: heavy tortuority

19. Discussions: A unique capacity for pushability to cope with blockages and tortuorities An extremely durable balloon to cope with high calcification and fibrosis http://www.clearstream.ie/index.cfm?area=product&action=productdetail&menuid=204&productid=27&productnameid=3 ReeKross balloon catheter is

20. Conclusion: The ReeKross catheter is an effective and feasible instrument in treating iliofemoral CTO, with a high rate of technical success and an acceptable immediate procedure outcomes Reekross 18, has greater flexibility, making it suitable for a retograde procedure over the bifurcation.

21. Vascular Center of Shanghai Jiaotong University. Department of Vascular Surgery, 9th People’s Hospital Affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, China www.9thvascsurg.org