The results of subintimal angioplasty in a district general hospital.
OBJECTIVE
we report a prospective study to determine if subintimal angioplasty can be performed in non-teaching centres and to establish its learning curve.


METHODS
subintimal angioplasty was performed on 50 limbs in 46 patients (34 male) with a median age of 72 years (range 45-93 years). Indication was critical limb ischaemia (27 limbs) or intermittent claudication (23 limbs). Occlusions were located in the superficial femoral artery in 44 limbs, popliteal artery in 4 limbs and the peroneal artery in two limbs. At a median of 7.9 months patients had colour duplex imaging of the vessels that underwent angioplasty to assess vessel patency.


RESULTS
primary technical success was achieved in 39 cases (78%). Primary technical success was greater in the second group of 25 consecutive limbs to undergo angioplasty at 92% (23 cases) compared with the first 25 consecutive limbs at 64% (16 cases). At 6 months the overall vessel patency rate on duplex imaging was 57%, improving to 64% in the group having a primarily successful procedure. The equivalent rate of symptomatic improvement was 59 and 66% respectively. Complications occurred in five procedures, most were minor, but a single fatality was directly attributable to the procedure.


CONCLUSIONS
subintimal angioplasty can reasonably be performed outside major teaching institutions. There is a short learning curve associated with the procedure.
Shaw
M B K
MB
Department of Surgery, Derbyshire Royal Infirmary, London Road, Derby, UK.
DeNunzio
M
M
Hinwood
D
D
Nash
R
R
Callum
K G
KG
Braithwaite
B D
BD
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000193:education* / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D013997:Time Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency / Q000502:physiology