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

Abstract

Subintimal angioplasty is a safe and effective revascularization technique for the treatment of CTOs of the femoropopliteal artery. Provisional stenting may have a role at the subintimal entry or true lumen re-entry site.

Sustained Benefit at 2 Years for Covered Stents Versus Bare-Metal Stents in Long SFA Lesions: The VIASTAR Trial

“…However, the durability of percutaneous transluminal balloon angioplasty (PTA) for long SFA lesions remains poor [3,4]. Primary stent placement in long SFA lesions has shown promising results in single-arm studies [5][6][7][8][9][10]. However, in bare-metal stents (BMS) the risk of in-stent restenosis and stent fracture grows with lesion length [11].…”

Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting

“…Operators should be vigilant of subacute or thrombus or acute-on-chronic occlusions that may produce distal thromboembolism (trashing) if the lesions appear to be too soft and the wire crosses easily without any resistance. Reentry devices may allow true lumen reentry (technical success [95 %) at the planned distal landing zone and limit inadvertent distal extension of the subintimal dissection plane [50].…”

Retrograde subintimal recanalization of a radial artery occlusion after coronary angiography using the palmar loop technique

“…The rationale of the SIA is to create a subintimal lumen with the GW, and after proper BA the new subintimal space is maintained open by the blood pressure. The technique has promising long term results in the femoro-popliteal and infra-inguinal tract [9,10], but we have no data on the below-the-ankle segment. The most important potential complication of the technique is the occlusion of the superficial or the deep palmar arch which must be prevented with careful wiring, and by using microcatheters and dedicated low profile balloons and GWs.…”