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Results: There were 63 iliac arteries, 45 femoropopliteal arteries, and 4 occluded stents. Mean occlusion length was 8.7 \u00b1 4.7 cm. Conventional recanalization was attempted first and was successful in 71 limbs (70%). Probing with the guidewire\u2019s stiff end was attempted in 33 of the 41 procedures where conventional techniques failed and was successful in 18 (54%), improving the overall procedural success rate to 80%. For the remaining 15 limbs, home-made directional sharp needle recanalization was attempted in 11 and was successful in 9 (82%), further improving the overall recanalization success to 88%. Procedural complications were self-limited or managed nonoperatively. Conclusions: Aggressive recanalization techniques in CTO following failure of traditional means are safe and can substantially improve procedural success rates.<\/jats:p>","DOI":"10.1177\/1538574410370375","type":"journal-article","created":{"date-parts":[[2010,5,18]],"date-time":"2010-05-18T22:41:46Z","timestamp":1274222506000},"page":"460-467","source":"Crossref","is-referenced-by-count":12,"title":["Impact of Aggressive Endovascular Recanalization Techniques on Success Rate in Chronic Total Arterial Occlusions (CTOs)"],"prefix":"10.1177","volume":"44","author":[{"given":"Melhem J.","family":"Sharafuddin","sequence":"first","affiliation":[{"name":"Department of Surgery, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA, , Department of Radiology, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamal 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