title: Improved technical success and midterm patency with subintimal angioplasty compared to intraluminal angioplasty in long femoropopliteal occlusions.
abstract: OBJECTIVE
  To compare the efficacy of subintimal angioplasty combined with primary stenting to intraluminal angioplasty with stenting for revascularization of long (>10 cm) femoropopliteal arterial occlusions.
  
  
  METHODS
  Baseline characteristics and outcomes of 52 patients (40 men; mean age 65.6+/-9.7 years) with superficial femoral artery (SFA) occlusions in 61 limbs (mean occlusion length 22.7+/-9.9 cm) treated with subintimal angioplasty and primary stenting were compared with a 54-patient control group (46 men; mean age 64.8+/-8.2 years) from our registry database who had intraluminal angioplasty with stenting in 60 limbs (mean occlusion length 22.0+/-8.5 cm).
  
  
  RESULTS
  All baseline clinical and angiographic characteristics showed no differences. In all patients, at least 1 self-expanding nitinol stent was implanted. Subintimal angioplasty was successful in 58 (95.1%) of 61 limbs, whereas technical success for the conventional approach was 86.7% (52/60 limbs; p = 0.11). In both groups, there were no major complications requiring surgery. Primary patency at 12 months for successful cases was 76.4% for subintimal angioplasty and 59.2% for conventional angioplasty (p = 0.06); on an intention-to-treat basis, including technical failures, the rates were 72.4% and 50.9%, respectively (p = 0.02).
  
  
  CONCLUSIONS
  Subintimal angioplasty combined with stenting was feasible, with a high technical success rate and better short and midterm results for revascularization of long femoropopliteal occlusions than the conventional intraluminal approach.
authors.affiliation: Division of Cardiology, Severance Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Dong-Hoon
authors.initials: DH
authors.lastname: Choi
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Won-Heum
authors.initials: WH
authors.lastname: Shim
mesh_terms: D000368:Aged; D000497:Alloys; D000800:Angioplasty, Balloon / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D011474:Prosthesis Design; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D017539:Tunica Intima; D014654:Vascular Patency
chemical_list: D000497:Alloys; C013616:nitinol