title: Subintimal angioplasty of lengthy femorotibial total occlusion in Buerger's disease.
abstract: OBJECTIVE
  To report successful subintimal angioplasty of a lengthy femorotibial occlusion in a patient with Buerger's disease, with wound healing and limb salvage.
  
  
  METHODS
  A 38-year-old female heavy smoker was referred to our hospital for treatment of extensive infectious tissue loss, with severe foot pain 1 month after early failure of a distal bypass graft. Angiography revealed total occlusion in the femoropopliteal and infrapopliteal arteries. Endovascular recanalization was attempted in order to establish "straight-line flow" to the foot on the verge of limb loss. The subintimal angioplasty technique with a 0.014-inch hydrophilic guidewire facilitated successful crossing of the occlusive femoropopliteal and posterior tibial arteries. The lesions were serially dilated (standard and cutting balloons). Angiography demonstrated antegrade flow to the foot without flow-limiting dissection, and the serious pain dramatically disappeared. Complete wound healing was observed 5 months after initial revascularization with the assistance of repeat angioplasty for restenosis.
  
  
  CONCLUSIONS
  Contemporary endovascular therapy using the subintimal angioplasty technique could represent a viable option for Buerger's disease.
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. kawarada90@hotmail.com
authors.forename: Osami
authors.initials: O
authors.lastname: Kawarada
authors.forename: Shinobu
authors.initials: S
authors.lastname: Ayabe
authors.forename: Hiroko
authors.initials: H
authors.lastname: Yotsukura
authors.forename: Takako
authors.initials: T
authors.lastname: Nakaya
authors.forename: Junji
authors.initials: J
authors.lastname: Kanayama
authors.forename: Koichiro
authors.initials: K
authors.lastname: Harada
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D017130:Angioplasty / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D013919:Thromboangiitis Obliterans / Q000150:complications; D017539:Tunica Intima