Subintimal Angioplasty for Advanced Lower Extremity Ischemia due to TASC II C and D Lesions of the Superficial Femoral Artery

Abstract

Objective: Subintimal angioplasty (SA) has evolved into a viable revascularization procedure for complex lower extremity lesions. Although patency rates are lower than those for autogenous bypass, limb salvage rates are comparable. This study reviewed the 8-year experience of SA in a single center.

Methods: Records of patients undergoing SA were reviewed. Clinical presentation and noninvasive exams were used to classify patients. Lesions were categorized by TransAtlantic InterSociety Consensus (TASC) II guidelines. Outcomes included technical success, patency, amputation-free survival, and limb salvage.

Results: 120 patients with TASC II C/D lesions underwent SA. Technical success was 91%. Primary patency at 6 and 12 months was 90% and 73%. Secondary patency at 6 and 12 months was 94% and 85%. One-year amputation-free survival was 90%. One-year limb salvage was 98%.

Conclusions: SA for TASC C/D lesions is a safe procedure and may be considered an alternative to bypass, especially in high-risk patients.

References

Conrad MF , Cambria RP , Stone DH , et al. Intermediate results of percutaneous endovascular therapy of femoropopliteal occlusive disease: a contemporary series. J Vasc Surg. 2006;44(4):762-769.

Taylor SM , Cull DL , Kalbaugh CA , et al. Comparison of interventional outcomes according to preoperative indication: a single center analysis of 2,240 limb revascularizations. J Am Coll Surg. 2009;208(5):770-778.

Tartari S. , Zattoni L. , Rizzati R. , et al. Subintimal angioplasty as the first-choice revascularization technique for infrainguinal arterial occlusions in patients with critical limb ischemia. Ann Vasc Surg. 2007;21(6):819-828.

Dosluoglu HH , Lall P. , Cherr GS , Harris LM , Dryjski ML Superior limb salvage with endovascular therapy in octogenarians with critical limb ischemia. J Vasc Surg. 2009;50(2):305-315, 316.

Lamuraglia GM , Conrad MF , Chung T. , Hutter M. , Watkins MT , Cambria RP Significant perioperative morbidity accompanies contemporary infrainguinal bypass surgery: an NSQIP report. J Vasc Surg. 2009;50(2):299-304, 304.

Bolia A. , Miles KA , Brennan J. , Bell PR Percutaneous transluminal angioplasty of occlusions of the femoral and popliteal arteries by subintimal dissection. Cardiovasc Intervent Radiol . 1990;13(6): 357-363.

Lazaris AM , Salas C. , Tsiamis AC , et al. Factors affecting patency of subintimal infrainguinal angioplasty in patients with critical lower limb ischemia. Eur J Vasc Endovasc Surg. 2006;32(6):668-674.

Antusevas A. , Aleksynas N. , Kaupas RS , Inciura D. , Kinduris S. Comparison of results of subintimal angioplasty and percutaneous transluminal angioplasty in superficial femoral artery occlusions . Eur J Vasc Endovasc Surg. 2008;36(1):101-106.

Scott EC , Biuckians A. , Light RE , Burgess J. , Meier GH 3rd , Panneton JM Subintimal angioplasty: our experience in the treatment of 506 infrainguinal arterial occlusions. J Vasc Surg. 2008; 48(4):878-884.

10.

Norgren L. , Hiatt WR , Dormandy JA , Nehler MR , Harris KA , Fowkes FG Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(suppl S):S5-S67.

11.

Rutherford RB , Baker JD , Ernst C. , et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517-538.

12.

Schillinger M. , Sabeti S. , Loewe C. , et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med. 2006;354(18):1879-1888.

13.

Treiman GS , Treiman R. , Whiting J. Results of percutaneous subintimal angioplasty using routine stenting. J Vasc Surg. 2006; 43(3):513-519.

14.

Adam DJ , Beard JD , Cleveland T. , et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366(9501):1925-1934.

15.

Surowiec SM , Davies MG , Eberly SW , et al. Percutaneous angioplasty and stenting of the superficial femoral artery. J Vasc Surg. 2005;41(2):269-278.

16.

Scott EC , Biuckians A. , Light RE , et al. Subintimal angioplasty for the treatment of claudication and critical limb ischemia: 3-year results. J Vasc Surg. 2007;46(5):959-964.

17.

Setacci C. , Chisci E. , de DG , Setacci F. , Iacoponi F. , Galzerano G. Subintimal angioplasty with the aid of a re-entry device for TASC C and D lesions of the SFA. Eur J Vasc Endovasc Surg. 2009; 38(1):76-87.

18.

Myers SI , Myers DJ , Ahmend A. , Ramakrishnan V. Preliminary results of subintimal angioplasty for limb salvage in lower extremities with severe chronic ischemia and limb-threatening ischemia. J Vasc Surg. 2006;44(6):1239-1246.

19.

Keeling AN , Khalidi K. , Leong S. , et al. Subintimal angioplasty: predictors of long-term success. J Vasc Interv Radiol. 2009; 20(8):1013-1022.