ArticleCVIR endovascular2026
Long-term outcomes of the "pave-and-crack" technique for severely calcified femoropopliteal chronic total occlusions.
Article in CVIR endovascular, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate the long-term safety and efficacy of the pave-and-crack technique, combining aggressive balloon dilatation and covered stent implantation, for endovascular therapy (EVT) of highly calcified femoropopliteal chronic total occlusions (CTOs) in poor surgical candidates unsuitable for open revascularization or conventional EVT.
designSingle-center retrospective cohort study based on a prospectively maintained peripheral artery disease database.
methodsPatients with symptomatic femoropopliteal CTOs treated using the pave-and-crack technique between September 2014 and April 2025 were included. Lesion and procedural characteristics, technical success, defined as residual stenosis ≤ 30%, complications, major target limb amputation, and symptom status were assessed. Kaplan-Meier analysis was used to estimate freedom from target lesion revascularization (TLR) and all-cause mortality through 5 years.
resultsA total of 122 patients with 136 femoropopliteal CTOs were treated. Mean lesion length was 253.0 ± 90.1 mm, and 93.4% (127/136) of lesions were severely calcified. Retrograde access was required in 72.8% (99/136) of procedures. Technical success was achieved in 93.4% (127/136). Freedom from target lesion revascularization was 91.4% ± 2.6% at 1 year, 77.9% ± 4.6% at 3 years, and 66.7% ± 7.2% at 5 years. Major target limb amputation occurred in four cases presenting with CLTI (8.5%; 4/47) and none with claudication (0%; 0/89). Five-year freedom from all-cause mortality was 71.4 ± 6.9% for claudicants and 41.4 ± 11.2% for patients with CLTI (p < 0.01).
conclusionThe pave-and-crack technique is feasible for highly calcified femoropopliteal CTOs, achieving high technical success, encouraging long-term freedom from TLR, and high limb salvage.
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