Effects of Subintimal Angioplasty in Patients with Ischemic Arterial Disease of Lower Extremities

ABSTRACT

PURPOSE: Although subintimal angioplasty (SIA) has been advocated to treat chronic lower extremity arterial occlusions, numerous reports have described differences in its results. We evaluated the effect of SIA in a group of patients with severe lower extremity arterial occlusive disease. METHOD: During a 5-month period, 6 limbs in 4 patients with arterial occlusions (mean length, 17.7 cm; range, 9 to 27 cm) were treated with SIA. Three limbs had gangrene, and all patients had resting pain. There were two external iliac-superficial femoral, two superficial femoral-popliteal and two femoral-popliteal-tibial artery lesions. With fluoroscopic guidance, via an antegrade common femoral artery puncture, a subintimal dissection plane was created across the occlusion with standard hydrophilic guidewire and catheter. The arterial lumen was reentered distal to the occlusion, and the recanalized segment was balloon (3 to 6 mm) dilated. RESULT: SIA was technically successful in all 6 limbs (100%). Pain was completely resolved and all areas of gangrene were healed. The mean increase in ankle-brachial index after SIA was 0.51 (range, 0.25 to 0.71). There was no significant complication related with SIA and all arteries were patent during 3.6-months mean follow-up period. CONCLUSION: SIA for long occlusions of the crural arteries is safe and effective and can be an excellent alternative to reconstructive surgery in elderly and frail patients.