Subintimal angioplasty of isolated infragenicular vessels in lower limb ischemia: long-term results.
OBJECTIVE
To assess the outcome of subintimal angioplasty in treating isolated infragenicular arterial disease in patients with severe lower limb ischemia.


METHODS
A retrospective study reviewed 67 consecutive patients (39 men; mean age 76 years, range 41-96) who underwent infragenicular subintimal angioplasty between March 1997 and May 2000 for ischemia in 70 limbs. The median length of occlusion was 6 cm [corrected] (range 1-10) in the below-knee popliteal arteries, 4 cm [corrected] (range 1-4) in the tibioperoneal trunk, 21 cm [corrected] (range 1-35) in the anterior tibial artery, 10 (1-30) in the posterior tibial artery, and 5 (range 1-20) in the peroneal artery.


RESULTS
The technical and clinical success rates were 86% and 80%, respectively. In the 10 (14%) patients with a technical failure, 3 underwent successful bypass, 4 had an amputation, 1 had a lumbar sympathectomy, and 2 were treated conservatively. Of the 4 (6%) limbs that did not achieve clinical success, 2 patients required femorodistal bypass and their ulcers improved; in the other 2, ulcerations did not heal completely. The cumulative limb salvage rate and freedom from critical limb ischemia (CLI) quantified by Kaplan-Meier life-table analysis were 94% and 84% at 36 months. Mortality rates were 19% at 1 year, 43% at 2 years, and 51% at 3 years. In a subgroup analysis, the rate of CLI was significantly lower in nondiabetics (4%) and than in diabetics (24%, p=0.02), but neither survival nor amputation rates were significantly different.


CONCLUSIONS
Subintimal angioplasty is a safe and effective procedure for treating isolated crural vessels in patients with severe lower limb ischemia.
Ingle
Hemant
H
Department of Surgery, Leicester Royal Infirmary, Leicester, England, UK.
Nasim
Ahktar
A
Bolia
Amman
A
Fishwick
Guy
G
Naylor
Ross
R
Bell
Peter R F
PR
Thompson
Matthew M
MM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D002908:Chronic Disease; D003925:Diabetic Angiopathies / Q000601:surgery; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000503:physiopathology; D012039:Regional Blood Flow; D012189:Retrospective Studies; D016019:Survival Analysis; D016909:Tibial Arteries / Q000503:physiopathology; D016896:Treatment Outcome