<b>Subintimal Angioplasty as a Primary Modality in the Management of Critical Limb Ischemia:</b>Comparison to Bypass Grafting for Aortoiliac and Femoropopliteal Occlusive Disease

Hynes, Niamh; Akhtar, Yousaf; Manning, Brian J.; Aremu, M; Oiakhinan, Kenneth; Courtney, D. F.; Sultan, Sherif

doi:10.1583/04-1242.1

Cited by 62 publications

(75 citation statements)

References 38 publications

(40 reference statements)

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“…In this extended series, complications were associated with age Ͼ80 years and poor preoperative functional status. 32 Thus, it is difficult to use these data directly to assess the risk of bypass for patients aged Ͻ65 years.…”

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confidence: 99%

Lower extremity bypass vs endovascular therapy for young patients with symptomatic peripheral arterial disease

Lepäntalo

Houbballah

Raux

et al. 2012

Journal of Vascular Surgery

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The uncertainty continues over the best approach to patients with symptomatic peripheral arterial disease. Medical therapy and risk factor modification is part of any treatment regimen; with this there is little disagreement. However, with the introduction of lesser invasive percutaneous technologies, the discussion regarding surgical and endovascular therapies has become more and more complicated. Unfortunately, there is a relative shortage of robust outcomes data to support many of our specific treatment recommendations. Younger patients are an especially troublesome patient cohort. They have consistently shown poorer outcomes after any intervention compared with older patients and may represent a subset of more aggressive atherosclerotic disease. Our debaters will discuss their preferred approaches to these difficult patients in the context of the currently available supporting literature.

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confidence: 99%

Lower extremity bypass vs endovascular therapy for young patients with symptomatic peripheral arterial disease

Lepäntalo

Houbballah

Raux

et al. 2012

Journal of Vascular Surgery

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“…A recent meta-analyses of several SIA studies, including 1549 and 2810 limbs, respectively, estimated that 1-year primary patency rate was approximately 50%. Limb salvage is the most widely accepted clinical outcome measure in the CLI population [33][34][35][36][37][38]. The overall limb salvage in our study was 64.9% and the reason beneath the fact that the limb salvage is higher than patency rates is that all of the cases had critical limb ischemia and endovascular intervention may provide sufficient blood supply needed for healing then by the time the vessels is occluded the demand of blood supply is decreased and the collateral developed is enough for the tissue viability.…”

Section: Discussionmentioning

confidence: 65%

Transluminal versus Subintimal Angioplasty for Management of Critical Limb Ischemia Patients with Femoropopliteal Occlusive Disease

Foad¹,

Eldaly²,

Eldin³

et al. 2015

J Health Edu Res Dev

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AimComparison between intraluminal and subintimal angioplasty with review of technique, factors affecting the success and complications with special emphasis on factors that could predict the wire route meanwhile using simple techniques. MethodsThis is a non-randomized study with prospectively collected data that included 159 patients presented from 2011 to 2014 to the vascular surgery department with critical chronic lower limb ischemia due to atherosclerotic femoropopliteal occlusive disease for whom percutaneous angioplasty was done. Patients presenting with nonsalvageable limbs requiring primary major amputation and non-atherosclerotic causes of CLI were excluded. Results 75.5% of the lesionswere crossed transluminally while 19.5% of the lesions were crossed subintimally. In 8 cases (5%) the lesion could not be passed. The overall technical success to pass the lesion was 95%. On 24 months follow up, 1ry patency, 2ry patency, limb salvage in intraluminal group are 56.8%, 60.2% and 66.1% respectively while in subintimal group 46.7%, 46.7% and 60% respectively. Subintimal was more in the TASC D, lesion more than 10 cm and in contralateral access (P value was<0.05). There were no statistically significant differences between intraluminal and subintimal angioplasty regarding the outcome (Patency and limb salvage). ConclusionsThe passage of the wire is affected by length of the lesion, the TASC II classification of the lesion and access site with the subintimal passage was more in Lesion more than 10 cm, TASC D lesions and in contralateral access. These factors can be used prospectively as predictors for passage of the wire whether intraluminal or subintimal. In spite of the technical differences between the intraluminal and subintimal passage, yet they show no significant statistical differences regarding the outcome (patency and limb salvage). Hence both should be used as part of vascular armamentarium for revascularization in such frail patients.

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“…T. (30). Dauguma autorių teigia, kad techninė SA sėkmė labai priklauso nuo atlikėjo patirties (26,35,38,41). Mūsų duomenys tą patvirtino, nes pirmųjų dešimties SA metu pasitaikė daugiau kaip pusė techninių nesėkmių.…”

Section: Paviršinės šLaunies Arterijos Užakimas Kai Užakusiunclassified

“…Nedidelė dalis ligonių gulėjo kituose Kauno medicinos universiteto klinikų skyriuose ir jiems įvertinti lovadienius dėl paviršinės šlaunies arterijos užakimo sunku, nes jiems kartu gydytos ir kitos ligos. N. Hynes paskaičiavo, kad po sėkmingų SA ligoniai stacionare gydomi statistiškai reikšmingai trumpiau nei po jungties suformavimo operacijų (26).…”

Section: Paviršinės šLaunies Arterijos Užakimas Kai Užakusiunclassified

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Subintimal angioplasty for superficial femoral artery occlusions: first experience in Kaunas University of Medicine Hospital

Aleksynas¹,

Kaupas

2006

Medicina

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Kardiologijos instituto Invazinės kardiologijos laboratorija ĮvadasĮvairaus laipsnio periferinė arterijų liga JAV žmo-nėms vyresniems kaip 70 metų diagnozuojama 10 procentų atvejų, o tai sudaro apie 10 milijonų žmonių grupę (1). Dažniausiai periferinė arterijų liga pasireiškia protarpiniu raišavimu. Žmonių, kuriems atsirado protarpinis šlubavimas, 5, 10 ir 15 metų mirtingumas sudaro atitinkamai -30, 50 ir 70 procentų (2). Mirties priežastis yra širdies ir vainikinių arterijų nepakankamumas, kurį didina rūkymas, cukrinis diabetas ir lėtinės dializės. Žmonių, sergančių kritine kojų išemija (ramybės skausmai arba negyjančios žaizdos), penkerių metų mirtingumas -70 procentų, o 10 metų mirtingumas padidėja iki 85 procentų (3). Pacientų po chirurginės kojos išemijos operacijos penkerių metų išgyvenamumas siekia nuo 50 iki 60 procentų (4, 5). Apie 80 procentų ligonių, sergančių periferine arterijų liga, miršta nuo kraujagyslių patologijos. Iš jų apie 60 procentų miršta nuo išeminės širdies ligos, 10 procentų -nuo insulto (6). Populiacijos grupėje nuo 40 iki 60 metų vien protarpinis raišavimas nustatomas 2 proc. žmonių, o vyresnių kaip 70 metų grupėje nustatoma jau 6 proc. Populiacijai senstant, 2040 metais žmonių, sergančių periferine arterijų liga, skaičius padidės iki 22 procentų (7). Atsižvelgiant į JAV tyrėjų pateiktus duomenis, galima teigti, jog Lietuvoje situacija yra panaši.Subintiminė arterijų angioplastika (SA) -tai nuo aterosklerozės užakusių arterijų endovaskulinis gydymo metodas, kai, naudojant specialias priemones, * The full-length article in English can be found at

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Subintimal Angioplasty as a Primary Modality in the Management of Critical Limb Ischemia:Comparison to Bypass Grafting for Aortoiliac and Femoropopliteal Occlusive Disease

Cited by 62 publications

References 38 publications

Lower extremity bypass vs endovascular therapy for young patients with symptomatic peripheral arterial disease

Lower extremity bypass vs endovascular therapy for young patients with symptomatic peripheral arterial disease

Transluminal versus Subintimal Angioplasty for Management of Critical Limb Ischemia Patients with Femoropopliteal Occlusive Disease

Subintimal angioplasty for superficial femoral artery occlusions: first experience in Kaunas University of Medicine Hospital

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