Outcomes of reinterventions after subintimal angioplasty

Abstract

Endovascular reintervention after SIA is a safe and technically feasible procedure for recurrences and offers good limb salvage rate. Early reinterventions performed within 3 months of the original SIA portend a worse outcome. In addition, reinterventions are less durable in patients with CLI compared with claudication. Finally, by identifying a recurrent stenosis instead of an occlusion, close surveillance may contribute to improved overall outcome.

Transpopliteal Balloon-Assisted Excimer–Laser Atherectomy for the Treatment of Chronic Femoropopliteal Occlusions: Feasibility and Initial Results

“…A promising low reintervention rate of 25% (mean value after 8 months) in a relatively large collection has been reported. 25 Furthermore, there is the retrograde subintimal angioplasty, which showed a good procedural success (98%) with low complication rates. 26 A relatively high stent rate of about 71% and a restenosis rate of about 55% after 12 months reflect the complexity of those lesions.…”

Subintimal Recanalization Plus Stenting or Bypass for Management of Claudicants with Femoro-popliteal Occlusions

“…One of the limitations of SIA is the risk of re-intervention secondary to restenosis or rethrombosis, which worsen the clinical outcome. Schmieder et al, 17 in a series of claudicants and critical limb ischemia with femoropopliteal occlusions, reported a 25% re-intervention rate occurring earlydon average, 7.8 months after the initial intervention. This rate is similar to what has been reported for surgical bypass, as 15e20% of patients required revision, except that the mean time of these re-interventions was at 12e15 months.…”

2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

“…43,44 Revascularization decisions are based on many factors: clinical presentation, including severity of the patient’s symptoms and anticipated natural history; degree of functional limitation and QOL impairment; response to medical therapy, including structured exercise; and the likelihood of a beneficial short- and longer-term outcome, balanced against potential short-term (eg, bleeding, infection, MACE) and longer-term procedural risk. 1–3,5,6,23,45 Patient-centered discussions are critical in making appropriate decisions regarding revascularization and for building a trusting longitudinal relationship. More than 70% of patients prefer to have an active role in determining their treatment plan for claudication.…”

“…Revascularization procedures increase the risk of readmission and subsequent MALE, including restenosis and repeat intervention, and risk of ALI; thus, balancing risks and benefits is important. 1–3,5,6,45 The following factors should be considered in the shared decision-making process: possibility of symptomatic recurrence; development of more advanced symptoms, including ALI or CLTI; and the finite durability of revascularization procedures with potential need for repeat intervention(s). A specific tool for shared decision-making related to claudication has been developed and published.…”