Percutaneous transluminal angioplasty of occlusions of the femoral and popliteal arteries by subintimal dissection

Abstract

A technique for recanalization of femoral and popliteal arterial occlusions by intentional subintimal dissection is described. Recanalization with this technique was attempted in 71 occlusions of the femoro-popliteal segment with a mean length of 11.4 cm. Primary technical success was achieved in 54 (76%) cases, with complications occurring in 4 (5.6%). Of 44 successful cases reviewed at a mean follow up of 6 months, 37 (84%) were either asymptomatic or improved. The technique has proved to be an effective method of treating occlusions of the femoral and popliteal arteries with an acceptable complication rate. It may allow successful angioplasty where the standard intraluminal method fails, particularly when reconstructive surgery is the only option.

Retrograde Transpedal Access for Revascularization of Below-the-Knee Arteries in Patients with Critical Limb Ischemia after an Unsuccessful Antegrade Transfemoral Approach

“…The occlusion is then traversed in a retrograde and preferably intraluminal manner using either a 0.014'' or 0.018'' straight CTO guidewire as mentioned above. In the case of a subintimal passage, we use an angled tip guidewire supported by a balloon catheter to penetrate the intima from the subintimal space thus gaining re-entry into a nonor less-diseased vessel segment as has been reported earlier for femoro-popliteal revascularization procedures [12]. Support catheters are not used.…”

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

“…A combined antegrade and retrograde subintimal recanalization was subsequently planned. The occluded tract of the SFa to the popliteal artery above the knee was recanalized by subintimal antegrade dissection as described by Bolia et al [6], using a 180-cm, 0.035-in. Terumo stiff guidewire (Boston Scientific, Natick, MA) and a 5F Van Handel catheter (Cook, Bloomington, IN).…”

“…This technique is a good option in the case of a short superficial femoral artery (SFa) obstructions, but since the first experience of Bolia et al [6], the subintimal technique is often preferred, especially in long occlusions (>5 cm), because of the poor patency of the intraluminal revascularization [7][8][9].…”

Rupture of pseudoaneurysm of the superficial femoral artery over four years after self-expandable nitinol stent implantation

“…However, interventionists must first recanalize an occluded segment before considering stent placement. Subintimal angioplasty was recently introduced as an alternative to conventional intraluminal recanalization in the EVT of long-segment occlusions, particularly in the SFA [7]. The procedure is relatively simple and does not require extensive manipulations or operator experience.…”