Clinical Outcomes of Subintimal vs. Intraluminal Revascularization Approaches for Long Femoropopliteal Occlusions in a Korean Multicenter Retrospective Registry Cohort

Abstract

a totally occluded segment via intentional creation of a subintimal channel. Since this approach was first described by Bolia et al in 1989, 3 the subintimal approach has been widely used to overcome long chronic arterial occlusions. 2,4-6 Furthermore, the more recent introduction of re-entry devices and the adoption of bidirectional wiring approaches have improved the technical success of the subintimal approach for femoropopliteal lesions. 7 In addition, implantation of self-expanding nitinol stents further contributes to increased patency rates after this procedure. 1,7-9 Despite these recent advances in the outcomes of the subintimal T he femoropopliteal artery is the longest arterial segment that is exposed to various forces induced by leg movements and frequently affected by the atherosclerotic process. Over the past decade, self-expanding nitinol stents have significantly improved the outcomes of endovascular therapy for femoropopliteal artery disease; 1 however, the technical success and durability of patency after endovascular treatment in this arterial segment have been challenged by common lesion characteristics, such as long occlusions and calcifications. 2 The subintimal approach is a technique that recanalizes Background: There are limited data comparing the outcomes of subintimal vs. intraluminal approach in the treatment of long femoropopliteal artery occlusions. The objective of this study was to investigate the efficacy and safety of the subintimal approach for long femoropopliteal artery occlusions.

IVUS-Guided Wiring Improves the Clinical Outcomes of Angioplasty for Long Femoropopliteal CTO Compared with the Conventional Intraluminal Approach

“…Previous studies have failed to prove that the intraluminal approach has a clinical benefit compared with the subintimal approach [2][3][4] . However, in these studies, intraluminal and subintimal approaches were classified based on the wiring method and/or the size of the guidewire.…”

SFA Intervention: Intraluminal or Subintimal?

“… 24) Other comparative studies found no difference in the technical success rates for the 2 strategies. 21) 22) 24) However, Soga et al 22) reported that 25% of the IA cases in their study crossed over to a subintimal approach due to technical difficulties during IA. SA also had a significantly shorter procedure time, lesser use of guidewires, body surface echography, and IVUS.…”

“…Overall, procure-related complication rates do not significantly differ between the 2 endovascular strategies. 20) 22) Only Kim et al 24) reported a higher major complication rate (4.1% vs. 0.4%) with SA. However, they still found similar incidence of distal embolizations and arterial ruptures for the 2 treatments.…”

“…However, as operators accumulated experience and adopted retrograde approaches from distal arteries and using re-entry devices, the technical success rate gradually improved ( Tables 1 and 2 ). 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) 22) 23) 24) …”

“…One prospective registry study and four retrospective studies have compared the immediate and mid-term outcomes for both wire crossing techniques. 20) 21) 22) 23) 24) …”