Accessing Peripheral Occluded LesiOns II (APOLO-II) (APOLO-II)

Inclusion Criteria:

• Documentation from a previous attempt OR a concurrent reasonable attempt (at least 5 minutes) during this procedure, demonstrating resistance to conventional guidewire crossing;
• Patient must have objective evidence of lower extremity ischemia;
• Totally occlusive lesion in a native femoropopliteal artery classified angiographically as absolute (100% occlusion with no flow), where no antegrade filling beyond the occlusion is visible;
• Target occlusion length is >1cm and ≤ 30 cm;
• Patient's reference vessel diameter is ≥ 4.0 mm and ≤6.0 mm (by visual angiographic estimation)
• Patient must be an acceptable candidate for PTA, peripheral artery bypass surgery or peripheral artery stent implantation;
• Female patients of child bearing potential must have a negative pregnancy test within 48 hours prior to the study procedure;
• Patient must have been informed of the nature of the study, agree to its provisions, and provide written informed consent;
• Patient is ≥ 21 years of age.

Exclusion Criteria:

• Patient has hypersensitivity or contraindication to aspirin, heparin, Plavix or radiographic contrast agents which cannot be adequately pre-medicated;
• The patient requires immediate treatment in more than one occluded vessel, in any combination of grafts or native vessels;
• Patient has planned femoropopliteal intervention scheduled within 30 days after index procedure;
• The patient is currently participating in another investigational drug or device trial that may conflict with study data collection and has not completed the entire follow-up period;
• Patient has no collateral flow distal to the occlusion;
• Patient's target occlusion has a dissection that occurred within the past 30 days caused by a guidewire attempt;
• Patient has a history of bleeding diatheses, coagulopathy or will refuse blood transfusion in cases of emergency;
• Patient suffered recent (within the past 6 months) significant gastrointestinal (GI) bleeding;
• Patient's target lesion or the vessel proximal to the target lesion reveals significant ectasia, dissection, aneurysm or thrombus;
• Patient has other medical illnesses (i.e., cancer or congestive heart failure) that may cause the patient to be non-compliant with the protocol, confound the data interpretation or is associated with life-expectancy less than 1 year.