Subintimal Angioplasty: Feasible and Durable

Abstract

Objective. To assess prospectively the feasibility and durability of subintimal angioplasty (SA) clinically and by duplex scans every 3 months. Patients and methods. Within a period of 54 months, we selected 96 patients with 100 occlusions (mean length: 11.5 cm) of femoro-popliteal or tibial arteries, for SA. Results. The technical success rate was 88% and seven out of 12 failures were treated by conventional surgery. Five belowthe-knee amputations were performed despite a patent recanalization. The following complications occurred: arterial perforation (6), arterial thrombosis (4), extensions beyond the planned re-entry site (5), and arterial dissection (2). Primary, assisted-primary and secondary patency rates were 61, 68 and 74%, respectively at 24 months. The 24 month-limb salvage and survival rates were 78 and 85%, respectively. Duplex imaging demonstrated 10 restenosis (five symptomatic . 70%, five asymptomatic 30 -70%), seven occlusions (five asymptomatic, two symptomatic treated by a bypass) and one asymptomatic dilatation. Conclusion. In a selected group of patients SA is feasible with a high initial technical success rate. SA is a good alternative in patients who are poor candidates for bypass surgery.

Angioplastia subintimal sem o uso de stent em paciente diabético portador de lesão complexa no pé

“…12 Puskas et al reported a 34% incidence of surgical wounds of the lower limbs submitted to saphenous vein stripping for myocardial revascularization. 13 Subintimal angioplasty without stenting has been widely approached in the literature, [1][2][3][4][5][6][7][8][9][10][11] and is corroborated by our case report.…”

“…The evolution shown by this patient corroborates the high rates of limb salvation in series of subintimal angioplasty. [9][10][11] The patient had lymphangitis, which extended from the foot until the lower third of the thigh. This finding is a contraindication to revascularization by open technique, considering the potential complications of surgical wound.…”

Multicentre randomised controlled trial of the clinical and cost-effectiveness of a bypass-surgery-first versus a balloon-angioplasty-first revascularisation strategy for severe limb ischaemia due to infrainguinal disease. The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial

“…This point estimate of the cost-effectiveness over 3 years generates a 'cost per QALY' of £134,257 [£3533/ (9.6/365. 25)].…”

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

“…Priklausomai nuo imčių dydžio taikytas tikslusis Fišerio (mažoms imtims) ir asimptominis chi kvadrato (c 2 ) kriterijus. (28) 61 proc. T. Florenes (23) 69 proc.…”