title: [Subintimal recanalization. Indications, technique and results].
abstract: OBJECTIVE
  This article gives an overview of the current importance of so-called subintimal recanalization in the lower extremities.
  
  
  METHODS
  The primary technical goal of endovascular interventions in the lower extremities is the endoluminal restoration of blood circulation from the iliac arteries into the feet.
  
  
  METHODS
  If endoluminal recanalization of e.g. high-grade flow-relevant stenoses or chronic total occlusion (CTO) is technically not possible, subintimal recanalization is a promising option and the only remaining minimally invasive alternative. During subintimal recanalization a channel is intentionally generated in the vessel wall (dissection) in order to bypass e. g. a chronic vascular occlusion over as short a distance as possible.
  
  
  METHODS
  The technical success rate for subintimal recanalization of CTO of the lower extremities is 65-100 %. Technical failure occurs in approximately 25 % using the catheter and wire technique and is caused in most cases by difficulties in reaching the true lumen after the subintimal passage (the so-called re-entry).
  
  
  RESULTS
  Compared to conventional subintimal recanalization, in recent years so-called re-entry devices have expanded the technical possibilities and depending on the medical experience and training level of the physician, provide an improvement in the technical success rate, a lower complication rate, a reduction of fluoroscopy time and the amount of necessary contrast medium but also result in higher costs.
  
  
  CONCLUSIONS
  Subintimal recanalization, whether carried out conventionally with a catheter and wire or using re-entry devices, of high-grade stenoses or CTO in the lower extremities provides a high technical success rate but requires an experienced and trained physician who is capable of operating the elaborate materials and mastering any possible complications.
authors.affiliation: Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. Boris.Radeleff@med.uni-heidelberg.de.
authors.forename: B
authors.initials: B
authors.lastname: Radeleff
authors.affiliation: Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Sumkauskaite
authors.affiliation: Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: N
authors.initials: N
authors.lastname: Kortes
authors.affiliation: Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Gnutzmann
authors.affiliation: Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Mokry
authors.affiliation: Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: H U
authors.initials: HU
authors.lastname: Kauczor
authors.affiliation: Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: U
authors.initials: U
authors.lastname: Stampfl
mesh_terms: D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000601:surgery*; D016896:Treatment Outcome; D017539:Tunica Intima / Q000601:surgery*
keywords: Chronic total occlusion (CTO); Critical limb ischemia (CLI); Intravascular ultrasound (IVUS); Percutaneous intentional extraluminal recanalization (PIER); Percutaneous transluminal angioplasty (PTA)