Subintimal angioplasty: feasible and durable.
OBJECTIVE
To assess prospectively the feasibility and durability of subintimal angioplasty (SA) clinically and by duplex scans every 3 months.


METHODS
Within a period of 54 months, we selected 96 patients with 100 occlusions (mean length: 11.5 cm) of femoro-popliteal or tibial arteries, for SA.


RESULTS
The technical success rate was 88% and seven out of 12 failures were treated by conventional surgery. Five below-the-knee amputations were performed despite a patent recanalization. The following complications occurred: arterial perforation (6), arterial thrombosis (4), extensions beyond the planned re-entry site (5), and arterial dissection (2). Primary, assisted-primary and secondary patency rates were 61, 68 and 74%, respectively at 24 months. The 24 month-limb salvage and survival rates were 78 and 85%, respectively. Duplex imaging demonstrated 10 restenosis (five symptomatic >70%, five asymptomatic 30-70%), seven occlusions (five asymptomatic, two symptomatic treated by a bypass) and one asymptomatic dilatation.


CONCLUSIONS
In a selected group of patients SA is feasible with a high initial technical success rate. SA is a good alternative in patients who are poor candidates for bypass surgery.
Desgranges
P
P
Department of Vascular Surgery, Henri Mondor Hospital, Creteil, France.
Boufi
M
M
Lapeyre
M
M
Tarquini
G
G
van Laere
O
O
Losy
F
F
Mellière
D
D
Becquemin
J P
JP
Kobeiter
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D005240:Feasibility Studies; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D015993:Life Tables; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D011446:Prospective Studies; D016909:Tibial Arteries / Q000000981:diagnostic imaging; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency