Subintimal angioplasty in the treatment of chronic lower limb ischemia.
OBJECTIVE
To present our experience with subintimal angioplasty (SA) for treatment of chronic lower limb ischemia (CLLI) and to assess its effectiveness and durability.


METHODS
From April 2003 through June 2005, we treated 40 limbs in 36 patients with CLLI by SA. Balloons with or without secondary stent placement appropriate in size to the occluded arteries were used for SA of all lesions, except for iliac lesions where primary stent placement was done. The patients were followed for 1-23 months by clinical examination and color Doppler ultrasound and/or CT angiography. Technical results and outcomes were retrospectively evaluated. The presence of a steep learning curve for performance of SA was also evaluated. Primary and secondary patencies were determined using Kaplan-Meier analysis.


RESULTS
Technical success was achieved in 32 (80%) of 40 limbs. There was no statistical difference between technical success rates of 75% (18/24) during the first year and 88% (14/16) thereafter. There were four complications (10%) in 40 procedures; two arterial perforations, one pseudoaneurysm at the puncture site, and one delayed hematoma at the SA site. Excluding initial technical failures, the primary patency rates at six and 12 months were 68% and 55%, respectively. Secondary patency rates at six and 12 months were 73% and 59%, respectively.


CONCLUSIONS
Subintimal angioplasty can be accomplished with a high technical success rate. It should be attempted in patients with CLLI as an alternative to more extended surgery, or when surgical treatment is not recommended due to comorbidity or an unfavorable disease pattern.
Cho
Sung Ki
SK
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Do
Young Soo
YS
Shin
Sung Wook
SW
Park
Kwang Bo
KB
Kim
Dong-Ik
DI
Kim
Young Wook
YW
Kim
Duk-Kyung
DK
Choo
Sung Wook
SW
Choo
In Wook
IW
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D002908:Chronic Disease; D015897:Comorbidity; D003251:Constriction, Pathologic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery; D007511:Ischemia / Q000453:epidemiology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015607:Stents; D017539:Tunica Intima / Q000473:pathology