Re-Opening Leg Arteries: Approach to Chronic Total Occlusion

CTO lesions frequently show neovascularization and the formation of recanalization microchannels that run parallel to the occluded vessel. Revascularization may be surgical or endovascular and choosing the optimal method involves consideration of both patient and anatomical factors. Patient factors include the symptomology at presentation (Rutherford classification), surgical risk, medical comorbidities, and availability of conduit if surgical management is considered. Anatomical considerations include the burden of disease, vascular anatomy with regard to inflow and runoff, and the degree of calcification.