Subintimal versus intraluminal recanalization of chronic iliac occlusions.
OBJECTIVE
To present our experience with subintimal recanalization of chronic iliac occlusions and retrospectively compare the results of this technique with those of standard intraluminal recanalization.


METHODS
A retrospective review was conducted of 98 patients (91 men; mean age 61+/-10 years, range 37-77) with unilateral chronic iliac occlusions who underwent standard intraluminal recanalization or subintimal recanalization if intraluminal wire passage failed. The technical success, complications, and patency rates were statistically compared between groups.


RESULTS
In 59 (60%) of 98 patients, the occlusions were successfully crossed with ipsilateral intraluminal recanalization, while failure of intraluminal recanalization in the remaining 39 led to attempted subintimal recanalization (ipsilateral in 17 and antegrade-retrograde in 22). Overall, ipsilateral intraluminal recanalization was technically successful in 56 (57%) of 98 patients; subintimal recanalization was successful in 35 (90%) of 39 patients. Technical success was only 29% in 17 patients who underwent subintimal recanalization via an ipsilateral retrograde approach. During a follow of 27+/-16 months, primary and assisted primary patencies were not significantly different between the patients treated with intraluminal versus subintimal recanalization (p=0.81 and 0.64, respectively).


CONCLUSIONS
Subintimal recanalization is a safe and effective supplement to standard intraluminal recanalization techniques in the endovascular treatment of chronic iliac occlusions. Because of the poor outcome associated with the ipsilateral route, subintimal recanalization of these lesions should preferably be performed via a combined antegrade-retrograde approach.
Yilmaz
Saim
S
Department of Radiology, Akdeniz University School of Medicine, Arapsuyu 07070, Antalya, Turkey. ysaim@akdeniz.edu.tr
Sindel
Timur
T
Lüleci
Ersin
E
D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007083:Iliac Artery; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*