The Early Outcome of the Endovascular Subintimal Angioplasty for Chronic Critical Limb Ischemia in Infrainguinal Vascular Disease

ABSTRACT

PURPOSE: Elderly patients with infrainguinal vascular disease and chronic critical limb ischemia are poor surgical candidates. The purpose of this study was to evaluate the safety and efficacy of infrainguinal endovascular subintimal angioplasty as a primary treatment for chronic critical limb ischemia. METHOD: We evaluated patients with infrainguinal endovascular subintimal angioplasty, retrospectively. From August 2005 to October 2006, 10 limbs in 10 patients aged 70+/-9.30 years-old with critical limb ischemia received an infrainguinal endovascular subintimal angioplasty. The risk factors for arteriosclerosis obliterans were diabetes mellitus (8 cases, 80%), hypertension (5 cases, 50%), ischemic heart disease (3 cases, 30%), and stroke (2 cases, 20%). Seven out of 10 (70%) patients had chronic non-healing wounds. Among 10 patients, primary stent implantation (4 legs) or ballooning (9 legs) were performed. The patency was evaluated using computed tomographic angiography or duplex scanning with Doppler and the ankle-brachial index (ABI) measurement. RESULT: The primary procedure success rate was 100% (10 of 10). The restenosis rates at follow up at 7+/-4.8 months after the primary endovascular subintimal angioplasty was 10% (1 of 10). There were no major complications and no deaths. A 90% cumulative primary patency rate and a 90% cumulative limb salvage rate were observed as determined by the Kaplan-Meier analysis. CONCLUSION: Infrainguinal endovascular subintimal angioplasty may be feasible, safe and effective primary treatment for chronic critical limb ischemia with primary angiographic and clinical success, a low complication rate and a cumulative limb salvage rate comparable with surgical techniques. It may be a useful alternative in older patients with a high surgical risk.