C-77 | Real-World Clinical Application of the Detour Procedure: Technical Outcomes and Early Patency Using Percutaneous Transmural Arterial Bypass (PTAB) in Complex Femoro-Popliteal Occlusions

One of the most vexing challenges in peripheral vascular intervention has been the quest to achieve long-term patency in long-segment disease of the SFA. Historically, these lesions have been treated with open surgical bypass due to more favorable patency rates. It has, however, been long recognized, that the morbidity associated with this traditional surgical approach is not trivial. As a result, interventionalists have sought to use endovascular techniques on long lesions by extending the use of devices previously tested in much shorter lesions, hoping to extrapolate results. Despite advances in endovascular devices, patency rates in long occlusions remain modest. Percutaneous transmural arterial bypass (PTAB), also known as the Detour procedure, was developed to achieve or exceed patency rates of open surgical bypass in a much less invasive manner. We report on our early, post-market approval experience with PTAB in a series of complex infra-inguinal cases. Patients were identified as appropriate based on a combination of the device IFU, clinical necessity, and anatomy. The Detour procedure requires contralateral arterial access using standard crossover technique, and ipsilateral posterior tibial vein access. PTAB is accomplished by percutaneously bypassing the SFA and deploying a series of modular Torus stent grafts around the lesion, using the adjacent femoral vein as a conduit. The proximal and distal anastamoses are created using an EndoCross device, that fires a hollow-tube, nitinol needle through the arterial and venous walls above and below the lesion. From July 14, 2023 to January 26, 2024 we performed 27 successful, consecutive PTAB's at Salinas Valley Health (20) and El Camino Health (7) in Northern California. We treated 22 men and 5 women with lesion lengths of 42±4cm. Severe calcification was present in 81% and impaired runoff in 88%. Technical success was 100% and median procedure time was 90 minutes. PTAB patency at 1 month was 100% with no DVT's. Initial experience with PTAB in the post-market approval stage is promising and can be applied to a variety of complex lesions. Longer term follow-up and larger numbers of patients treated are needed to validate this new approach.