New techniques and developments to treat long infrainguinal arterial occlusions: Use of reentry devices, subintimal angioplasty, and endografts

The endovascular recanalization of long infrainguinal arterial occlusions has made significant progress in the past decade. The technique of subintimal angioplasty has opened the door to the treatment of lesions uncrossable using standard transluminal approaches. With the advent of new wires and catheters designed to traverse long lesions, and reentry devices used to facilitate the subintimal approach, percutaneous treatment has made substantial inroads into territory previously dominated by surgical bypass. Advances in stent technology have improved deliverability and patency in these difficult applications. Percutaneously delivered covered endografts into the femoropopliteal segment may allow better patency by performing like endoluminal prosthetic bypasses. In this article, we review the latest technology available to treat occlusions of the femoropopliteal arterial segment.