Chronic total occlusions are a common cause of both claudication and critical limb ischemia. Currently, 40%-50% of all individuals undergoing lower extremity interventions will have a chronic total occlusion. Endovascular specialist should be familiar with the different treatment algorithms and classifications systems. Many different techniques have been shown to be successful in crossing the lesion and for re-entry when needed. The vascular access obtained to cross the lesion is frequently dictated by lesion location, lesion length, and the distal runoff in the affected limb.
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