Purpose: To investigate the midterm outcomes of
subintimal angioplasty in occluded superficial femoral arteries (SFA) and
evaluate the clinical and procedural factors affecting these results.
Methods: Between April 2004 and April 2012, 150
patients (122 men; mean age 69±10 years) with chronic total occlusions in
the SFA underwent subintimal angioplasty with primary stenting in 172 limbs. The
average lesion length was 22.6±8.5 cm. Stents were routinely implanted at
the proximal entry into the subintimal channel. The primary endpoint was binary
restenosis.
Results: Technical success was achieved in 161
(94%) limbs; there were no procedure-related deaths or complications
requiring surgery, but distal embolization and arterial perforation occurred in
2 and 4 limbs, respectively. The cumulative freedom from binary restenosis rates
at 1 and 3 years were 77% and 59%, respectively, in the entire
study group. The 96 patients without critical limb ischemia (CLI) had
significantly higher patency rates at 1 and 3 years (84% and 66%,
respectively) than the 54 patients with CLI (66% and 43%,
respectively; p=0.011). Based on multivariate analysis, a larger number
of stents, lower post-procedure ankle-brachial index, and lower body mass index
were each independent predictors of binary restenosis.
Conclusion: Subintimal angioplasty with routine
stenting at the proximal stump is safe and effective for the treatment of
chronic total SFA occlusions.
BoliaABrennanJBellPR.
Recanalisation of femoro-popliteal occlusions: improving
success rate by subintimal recanalisation. Clin
Radiol.
1989;40:325.
2.
BoliaAMilesKABrennanJ. Percutaneous transluminal angioplasty
of occlusions of the femoral and popliteal arteries by subintimal
dissection. Cardiovasc Intervent Radiol.
1990;13:357–363.
3.
LondonNJSrinivasanRNaylorAR. Subintimal angioplasty of
femoropopliteal artery occlusions: the long-term results.
Eur J Vasc Surg.
1994;8:148–155.
TreimanGSTreimanRWhitingJ.
Results of percutaneous subintimal angioplasty using routine
stenting. J Vasc Surg.
2006;43:513–519.
6.
BoufiMDonaBOrsiniB. A comparison of the standard Bolia
technique versus subintimal recanalization plus Viabahn stent graft in the
management of femoropopliteal occlusions. J Vasc
Surg.
2010;52:1211–1217.
7.
LipsitzECOhkiTVeithFJ. Does subintimal angioplasty have a
role in the treatment of severe lower extremity ischemia?J Vasc Surg.
2003;37:386–391.
8.
ScottECBiuckiansALightRE. Subintimal angioplasty for the
treatment of claudication and critical limb ischemia: 3-year
results. J Vasc Surg.
2007;46:959–964.
9.
AntusevasAAleksynasNKaupasRS. Comparison of results of subintimal
angioplasty and percutaneous transluminal angioplasty in superficial femoral
artery occlusions. Eur J Vasc Endovasc
Surg.
2008;36:101–106.
10.
SiablisDDiamantopoulosAKatsanosK. Subintimal angioplasty of long
chronic total femoropopliteal occlusions: long-term outcomes, predictors of
angiographic restenosis, and role of stenting.
Cardiovasc Intervent Radiol.
2012;35:483–490.
11.
KimJSKangTSAhnCM. Efficacy of subintimal
angioplasty/stent implantation for long, multisegmental lower limb occlusive
lesions in patients unsuitable for surgery. J
Endovasc Ther.
2006;13:514–521.
12.
KoYGKimJSChoiDH. Improved technical success and
midterm patency with subintimal angioplasty compared to intraluminal
angioplasty in long femoropopliteal occlusions. J
Endovasc Ther.
2007;14:374–381.
13.
DiehmNPattynamaPMJaffMR. Clinical endpoints in peripheral
endovascular revascularization trials: a case for standardized
definitions. Eur J Vasc Endovasc Surg.
2008;36:409–419.
14.
KoYGShinSKimKJ. Efficacy of stent-supported
subintimal angioplasty in the treatment of long iliac artery
occlusions. J Vasc Surg.
2011;54:116–122.
15.
LazarisAMSalasCTsiamisAC. Factors affecting patency of
subintimal infrainguinal angioplasty in patients with critical lower limb
ischemia. Eur J Vasc Endovasc Surg.
2006;32:668–674.
LaxdalEJenssenGLPedersenG. Subintimal angioplasty as a treatment
of femoropopliteal artery occlusions. Eur J Vasc
Endovasc Surg.
2003;25:578–582.
18.
SchmiederGCRichardsonAIScottEC. Selective stenting in subintimal
angioplasty: analysis of primary stent outcomes. J
Vasc Surg.
2008;48:1175–1181.
19.
BrostowDPHirschATCollinsTC. The role of nutrition and body
composition in peripheral arterial disease. Nat Rev
Cardiol.
2012;9:634–643.
20.
GalalWvan GestelYRHoeksSE. The obesity paradox in patients with
peripheral arterial disease. Chest.
2008;134:925–930.
21.
KumakuraHKanaiHAizakiM. The influence of the obesity paradox
and chronic kidney disease on long-term survival in a Japanese cohort with
peripheral arterial disease. J Vasc Surg.
2010;52:110–117.
