Abstract 16621: Factors Influencing the Difficulty of Guidewire Passage in Duplex-Guided Endovascular Treatment for Femoropopliteal Chronic Total Occlusions

Introduction: Previous studies have shown the effectiveness of duplex-guided endovascular treatment (EVT) for femoropopliteal chronic total occlusions (FP-CTO). However, the factors that contribute to the difficulty of guidewire passage during duplex-guided EVT have not been clearly understood. Therefore, this study aimed to examine the factors associated with prolonged guidewire passage in the CTO segment using this method. Methods: In this single-center, retrospective analysis, data from patients who underwent duplex-guided EVT for FP-CTO from April 2018 to March 2023 were collected. The guidewire passage index (GPI), defined as the time required for guidewires to pass the CTO segment divided by the length of the CTO segment, was used. The study aimed to explore the correlation between the GPI and the personal backgrounds and lesion characteristics of the patients. Results: A total of 40 lesions in 35 patients (28 males, mean age: 75.8 ± 6.5 years) with consecutive de novo lesions were treated using duplex-guided EVT. The patients had a mean height of 162.0 ± 7.8 cm, weight of 58.9 ± 10.9 kg, body mass index (BMI) of 22.4 ± 3.4 kg/m 2 , and pre-EVT ankle brachial index (ABI) of 0.50 ± 0.19. The mean lesion length was 218.2 ± 67.8 mm, and the CTO length was 159.4 ± 85.0 mm. All procedures were successful, with an average time of 44 ± 48.2 min required for guidewires to pass the CTO segment and a GPI of 2.9 ± 2.7 min/cm. There was a negative correlation (–0.46) between the time required for guidewires to pass the CTO segment and age, while positive correlations were found between the time required for guidewires to pass the CTO segment and weight, BMI, lesion length, and CTO length (0.32, 0.44, 0.48, and 0.58, respectively). However, no associations were found between GPI and factors such as gender, hypertension, diabetes, dyslipidemia, renal insufficiency, smoking status, CTO length of 150 mm or more, Rutherford classification, Fontaine classification, or puncture site. Additionally, no correlations were found between GPI and age, height, weight, BMI, preoperative ABI values, lesion length, or CTO length. Conclusions: The patient background does not appear to have an impact on the difficulty of guidewire passage in duplex-guided EVT for FP-CTO.