SFA Intervention: Intraluminal or Subintimal?

Abstract

Subintimal angioplasty (SA) is an endovascular technique to recanalize an occluded arterial segment through an extraluminal channel between the intima and media. Since its introduction in 1989, the technical success rate has improved with the accumulation of procedural experience and the development of retrograde approaches and re-entry devices. To date, no randomized trial has compared SA with intraluminal angioplasty (IA) for chronic total occlusion (CTO) of the superficial femoral artery (SFA). Based on limited data from several registry studies, SA appears to achieve a higher technical success rate than IA, whereas mid-term primary patency rates are comparable for both endovascular wiring strategies for SFA CTO. Additional clinical data are needed to confirm that SA is as effective as IA. The optimal stenting strategy and role of drug-eluting technologies also need to be defined to improve SA outcomes.

Symptomatic superficial femoral artery pseudoaneurysm due to late stent fracture

“…Most of the prospective and retrospective studies were limited to a 1-or 2-year follow-up after stent implantation in the SFA and no further follow-up had been done yet. 2,9,10 These case reports demonstrate the need for continual follow-up of those patients who have undergone endovascular revascularization of the SFA with stent implantation. The relationship between time of formation of pseudoaneurysms and stent fracture is unknown.…”

Five-year outcomes after revascularization of superficial femoral artery occlusion using Ocelot catheter

“…When comparing re-entry devices, the safety and feasibility are similar if they are used in short CTO SFA. When performed in longer CTO the efficiency ratio is more encouraging when orbital atherectomy with OCT is used [17].…”

A multicenter prospective observational study appraising the effectiveness of the Supera stent after subintimal recanalization of femoro‐popliteal artery occlusion: The SUPERSUB II study

“…In addition, the sample is only moderate. Accordingly, our results and the relevant discussion should be viewed in the context of other studies reporting on the SuperSUB strategy as well as other competing revascularization and stenting strategies for lower limb arterial revascularization 20‐21 …”

“…Accordingly, our results and the relevant discussion should be viewed in the context of other studies reporting on the SuperSUB strategy as well as other competing revascularization and stenting strategies for lower limb arterial revascularization. [20][21] 6 | CONCLUSIONS Use of the Supera stent after successful subintimal recanalization of complex lower limb arterial lesions is associated with favorable procedural results, which are largely maintained over follow-up up to 24 months. Notably, the favorable impact of such SuperSUB strategy appears evident in terms of long-term patency, clinical outcomes, quality of life dimensions, and reduced resource use in comparison to a historical cohort of similarly complex patients.…”