title: Initial and 3-year results after subintimal versus intraluminal approach for long femoropopliteal occlusion treated with a self-expandable nitinol stent.
abstract: BACKGROUND
  Intraluminal femoropopliteal stenting enables favorable dilation and good immediate results; however, whether this contributes to long-term patency is unclear. We compared patency after femoropopliteal stenting for a long occlusion using either an intraluminal or subintimal approach.
  
  
  METHODS
  Between January 2004 and December 2011, 902 endovascular procedures using either an intraluminal approach (651 procedures) or a subintimal approach (251 procedures) for long femoropopliteal occlusion were analyzed retrospectively. The outcomes of this study were periprocedural complication; primary, assisted-primary, and secondary patency; and overall survival.
  
  
  RESULTS
  The mean follow-up period of survivors was 29 ± 16 months. Between the intraluminal and subintimal approach, technical success (91% vs 90%; P = .71) and periprocedural complications (11% vs 13%; P = .34) were similar. However, procedure time was significantly longer for the intraluminal approach (126 ± 63 minutes vs 98 ± 49 minutes; P = .003). The improvement of ankle-brachial index was also similar. A quarter of cases started with the intraluminal approach were switched to a subintimal approach. There was no significant difference in primary, assisted-primary and secondary patency at 3 years between the two groups (55% vs 53%; P = .30; 65% vs 74%; P = .11; and 80% vs 85%; P = .37). The 3-year overall survival also did not differ significantly between groups (84% vs 86%; P = .55). After adjusting for baseline differences, the subintimal approach was found to be similar to the intraluminal approach for primary patency (hazard ratio, 1.21; 95% confidence interval, 0.94-1.56; adjusted P = .14).
  
  
  CONCLUSIONS
  Initial result and 3-year patency was similar in both approaches. Given the longer procedure time and high crossover rate, we suggest that a subintimal approach may be preferred in the treatment of long femoropopliteal occlusions with stenting.
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan. Electronic address: sogacchy@yahoo.co.jp.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Soga
authors.forename: Osamu
authors.initials: O
authors.lastname: Iida
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.forename: Daizo
authors.initials: D
authors.lastname: Kawasaki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shintani
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Suematsu
authors.forename: Terutoshi
authors.initials: T
authors.lastname: Yamaoka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D011150:Popliteal Artery; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000497:Alloys; C013616:nitinol