Open AccessSuccessful subintimal angioplasty for leg ischaemia is dependent on length of occlusion, not site of lesion
Author(s) -
Boyle J. R.,
Perry D.,
Gonem N.,
Cowan A. R.,
Sutton G. L.,
Pemberton R. M.
Publication year - 2001
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.2001.01757-48.x
Subject(s) - medicine , angioplasty , ankle , occlusion , interquartile range , surgery , amputation , lesion , popliteal artery , ischemia , iliac artery , radiology , cardiology
Background: The development of subintimal angioplasty offers an endovascular approach to the treatment of long occlusions not suitable for conventional transluminal angioplasty; it remains, however, the remit of relatively few radiologists in specialist centres. The authors have adopted the technique in view of promising published results. Methods: Between May 1997 and July 2000, 50 patients had attempted subintimal angioplasty (median age 71 (interquartile range (i.q.r.) 61–80) years). Patients were divided into two groups by length of occlusion; 26 patients (group 1) had occlusions greater than 10 cm in length (iliac, one; superficial femory artery (SFA), 24; crural, one) and 24 patients (group 2) had occlusions of less than 10 cm (iliac, five; SFA, five; popliteal, nine; crural, five). The primary technical success rate, ankle: brachial pressure index (ABPI) before and after the procedure, complication rate and symptomatic improvement were recorded for both groups. Results: The groups were well matched for age and indication for intervention. Primary technical success was significantly better for occlusions of less than 10 cm than for the longer lesions (83 versus 50 per cent; P < 0·01) with corresponding significantly greater rises in ABPI ( P < 0·05). Complications included one death in each group, one amputation in group 2 and six in group 1, all after failed salvage grafts.Group 1 (> 10 cm) Group 2 (< 10 cm) PTechnical success 13 of 26 20 of 24 >0·01 * Median (i.q.r.) ABPI change 0·135 (−0·07 to 0ë23) 0·24 (0·145–0·355) 0·046 †* χ 2 test; † Mann–Whitney U testConclusion: Subintimal angioplasty gives excellent results for occlusions of less than 10 cm in length irrespective of arterial site. Results for longer lesions are poor, with failed subintimal angioplasty often precipitating urgent distal vascular reconstruction and associated high risk of major amputation. © 2001 British Journal of Surgery Society Ltd