Ultrasound-guided adjunct to endovascular treatment of long-segment femoropopliteal chronic total occlusion.

BACKGROUND: To describe the outcomes of endovascular treatment (EVT) using ultrasound (US) adjunct guidance for long-segment femoropopliteal chronic total occlusion (LSFP-CTO). METHODS: The medical record of 66 patients who underwent EVT, either conventional or US-guided, for LSFP-CTO recanalization at our institution between October 2016 and October 2023 was retrospectively reviewed. Baseline characteristics, procedural data, and clinical outcomes were analysed. Patency rates during post-procedural follow-up were evaluated using the Kaplan-Meier method. RESULTS: The mean total lesion length was 242.08 ± 37.57 mm and 249.84 ± 46.52 mm in the conventional EVT and US-guided EVT groups, respectively (p > 0.05). Technical success was achieved in 30 patients (93.75%) in the conventional EVT and 32 patients (94.12%) in the US-guided EVT group. Among patients with successful EVT, procedural time and contrast usage were lower in the US-guided EVT group than in the conventional group. No immediate complications of acute renal failure were observed in the US-guided EVT group. During post-procedural follow-up, no significant difference was observed in the incidence of access site complications between the two groups (6.3% vs. 2.9%, p > 0.05). A significant reduction in Rutherford category and an increase in ankle-brachial index were observed after US-guided EVT. Furthermore, the cumulative primary patency rate at 2 years was 79.4% in the US-guided EVT group, with no statistically significant difference between the groups. The overall limb salvage rate was 88.2% at 2 years in the US-guided EVT group. CONCLUSIONS: US-guided EVT is a feasible, safe, and effective adjunctive method for the treatment of LSFP-CTO, associated with low complication rates. This approach reduces procedural time and contrast usage while providing a real-time adjunctive technique for establishing arterial cannulation during EVT.