Subintimal angioplasty for the treatment of claudication and critical limb ischemia: 3-year results

Abstract

SIA for the treatment of lower extremity chronic arterial occlusions is technically feasible, results in minimal morbidity, and provides satisfactory revascularization without surgical bypass. Secondary patency is comparable to that of autologous vein bypass and is achieved with a low rate of reintervention. When used as first-line therapy, SIA provides most patients with limb salvage and freedom from surgical bypass at 3 years.

Subintimal Angioplasty of Long Chronic Total Femoropopliteal Occlusions: Long-Term Outcomes, Predictors of Angiographic Restenosis, and Role of Stenting

“…In the study by Treiman et al, routine full-lesion stenting after SIA resulted in poor vessel patency, e.g., as low as 18% after 3 years [13]. In contrast, Scott et al showed improved long-term primary patency rates using selective stenting, approximately 45% to 55% at 1 year and approximately 25% at 3 years [20,21]. In our series, by using stenting selectively as bail-out strategy, cumulative proportional primary patency was calculated at 80.1%, 42.3%, and 29.0% at 12, 24, and 36 months, respectively.…”

“…However, to date, either selective stenting or full-lesion stenting (i.e., ''fullmetal jacket'') has not proved its superiority compared with plain balloon angioplasty [13,21]. Of interest, in a recent study by Boufi et al, there was no primary patency benefit by employment of a covered stent to treat the whole subintimal tract [15].…”

Recanalization of the Native Artery in Patients with Bypass Failure

“…The other technical failure was attributable to the lack of a patent artery in the foot after occlusion of a femorotibial bypass graft. Our opinion is that successful recanalization of the arterial tract previously considered unsuitable for an endovascular approach is now enabled by the improved competency and experience of vascular specialists, especially in subintimal angioplasty technique [18][19][20][21], as well as the advances made in catheter and guidewire technology.…”

“…Considerable advances in interventional technique, with the availability of steerable guidewires, low-profile balloon angioplasty catheters, and the development of subintimal angioplasty technique, allow an endovascular approach to arterial lesions previously confined to bypass surgery [18][19][20][21].…”

Subintimal angioplasty and stenting in chronic total femoropopliteal artery occlusions: Early- and mid-term outcomes

“…There is also a group of patients with critical lower limb ischemia and significant co-morbidities who are not eligible for surgical interventions. Revascularization with SIA offers reduced rates of amputations and improves wound healing in patients with critical limb ischemia (CLI) in addition to improvement in claudication status in this group of patients [3][4][5][6]. Although SIA has been accepted as a successful technique especially in long chronic femoropopliteal occlusions, low patency rates compared with surgical bypass (56-70% at 1 year follow-up) remain the main criticism regarding its independent use [7][8][9].…”