Chronic Arterial Total Occlusions

What is CTO?

Chronic total occlusions (CTO) are a form of peripheral artery disease, where the entire vessel is completely blocked by cholesterol and inflammatory cells, preventing any blood to flow to the arm or leg. Often adjacent blood vessels will form collateral blood flow to maintain some blood flow to the limb.

What are the Symptoms of Arterial CTO?

Symptoms of CTO are similar to the discomfort associated with a severe narrowing of arteries of the arm or leg with discomfort typically worse with exertion and better with rest. Here are some symptoms:

• Arm/leg pain, cramping, tightness, fatigue – often worse with exertion/walking and relieved by rest

• Arm/Leg weakness, numbness

• Cool and/or pale hands/feet

• Weak or absent pulses in the hands/feet

• Decreased hair, nail growth

• Extremity wound/ulcer that is slow to heal or not healing

• Rest pain of the arm/leg, especially when sudden, is concerning for acute limb ischemia

How is Arterial CTO Diagnosed?

Testing in the setting of CTO includes:

• Ankle-Brachial Index (ABI)

• Upper/Lower extremity artery ultrasound

• CT and/or MR angiography

• Angiography

What are some Treatment Options for Arterial CTO?

Treatment for chronic total occlusions in the arteries of the limbs is similar to that of coronary and peripheral artery disease. It includes smoking cessation (when appropriate), additional risk factor modification to reduce likelihood of more plaque build up (similar to management for coronary artery disease), exercise, medication, and when necessary to restore blood flow, catheter-based treatments (atherectomy, angioplasty, stenting) or bypass surgery.