Subintimal angioplasty as a treatment of femoropopliteal artery occlusions.
OBJECTIVE
to report the results of subintimal PTA of femoropopliteal occlusions above the knee.


METHODS
a retrospective study.


METHODS
in the period from January 1997 to January 2002, 109 patients were submitted to 124 interventions. The indication for treatment was intermittent claudication in 78 cases and critical ischaemia in 46.


METHODS
all cases of subintimal angioplasty were prospectively registered. A review of all cases treated with subintimal PTA for above-knee femoropopliteal occlusions were done. Primary assisted haemodynamic patency rate was calculated on intention to treat basis and for successfully treated cases. Comparison of patency with respect to comorbidities, indication, runoff and occlusion length was done with univariate and multivariate analysis (Cox' regression).


RESULTS
technical success rate was 90%. Primary assisted patency rates at 6, 12 and 18 months were 43, 37 and 31% calculated on basis of intention to treat and 48, 42 and 35% for successfully treated cases. Diabetes mellitus and critical ischaemia were found to be independent risk factors for re-occlusion.


CONCLUSIONS
subintimal angioplasty is an alternative to open surgery for patients with femoropopliteal occlusions and intermittent claudication. The treatment is relatively atraumatic, complications are rare and in most cases treated with endovascular techniques. Patency rates are low. In cases of critical ischaemia, time can be important for outcome with respect to limb salvage. We therefore find that the poor patency rates of subintimal angioplasty of femoropopliteal occlusions contraindicate its use in the treatment of critical ischaemia with exception of cases unsuitable for surgical treatment.
Laxdal
E
E
Department of Vascular Surgery, Haukeland University Hospital, Bergen, Norway.
Jenssen
G L
GL
Pedersen
G
G
Aune
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods / Q000401:mortality; D001157:Arterial Occlusive Diseases / Q000453:epidemiology / Q000601:surgery*; D043211:Exodeoxyribonuclease V; D005090:Exodeoxyribonucleases; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007717:Knee / Q000098:blood supply / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D017539:Tunica Intima / Q000473:pathology / Q000601:surgery; D014654:Vascular Patency / Q000502:physiology
D005090:Exodeoxyribonucleases; D043211:Exodeoxyribonuclease V