Distal Reentry to Treat Lower Limb Chronic Total Occlusions Using a Novel Electrically Guided Reentry Device

Purpose: Distal reentry can be a challenging endeavor, with an average failure rate of 40% reported when standard techniques are used. To improve success rates, reentry devices that can redirect the guidewire into the true lumen after subintimal advancement have been developed; however, the failure rate with these devices has been reported to be up to 35%, mainly because of difficulty in tracking these devices over an 0.014-inch guidewire, crossing the aortic bifurcation with the device when contralateral access is used, and achieving reentry in the presence of a highly calcified vessel. We present a case report demonstrating the first in human deployment of a novel, electrically guided reentry device.

Materials and Methods: An 84-year-old man presented with bilateral critical limb ischemia and tissue loss of the right foot (Rutherford stage 5). The ePATH reentry catheter (Pathfinder Medical Ltd) was introduced over the 0.0.014-inch antegrade wire and positioned subintimally in the mid POP, and the retrograde wire, parked in the true lumen of the POP, was exchanged to the 0.018 ePATH target wire. The reentry catheter was oriented toward the target wire using the ePATH display, which indicates to the operator in real time when the needle window is facing the target wire. The needle was deployed, and the 0.014-inch wire was successfully advanced into the true lumen of the popliteal artery on the first attempt. The previously occluded segment was then successfully angioplastied and stented.

Results: Immediate clinical improvement to the patient’s rest pain was noted. The patient underwent further treatment on his contralateral leg and was then discharged. Tissue loss at the level of the right foot was completed healed at 10-week follow-up, and a biphasic right dorsalis pedis pulse was present at 6-month follow up.

Conclusions: The ePATH reentry catheter has been demonstrated to be safe and effective in achieving reentry in this complex infrainguinal arterial recanalization. This low-cost and innovative electric guided reentry technology is a promising solution and may potentially find application in different clinical scenarios, such as reentry in iliac or aortic chronic total occlusions, deep venous arterialization, percutaneous femoropopliteal bypass, and endovascular creation of arteriovenous fistula for dialysis.