Impact of subintimal angioplasty on treatment of critical leg ischaemia

Background: Distal bypass for critical leg ischaemia (CLI) is technically demanding and a physiological challenge to the patient. Angioplasty offers an attractive alternative, the application of which may be extended by subintimal techniques. This study reports on the immediate success of subintimal angioplasty and its impact on workload in this unit since the introduction of the technique in 1997. Methods: This was a retrospective review of a consecutive series of 166 legs (156 patients) with CLI treated by subintimal angioplasty from 1997 to 1999. Society for Vascular Surgery and International Society for Cardiovascular Surgery criteria were used to determine clinical status and patency. Results: From 1997 to 1998 the rate of subintimal angioplasty increased, with a corresponding reduction in major amputation and surgery rates ( P < 0·001, χ 2 test). The increase in surgical reconstruction in 1999 could reflect delayed treatment of patients with late occlusion of a previously dilated segment.1996 1997 1998 1999Surgical reconstruction for CLI 104 (71·2) 104 (59·8) 70 (36·5) 114 (50·4) Primary amputation 42 (28·8) 60 (34·5) 41 (21·4) 37 (16·4) Subintimal angioplasty 0 (0) 10 (5·7) 81 (42·2) 75 (33·2) Total 146 174 192 226Values in parentheses are percentagesThe technical success rate of subintimal angioplasty was 84·9 per cent (25 primary failures). Twelve proceeded to bypass surgery, with one occluded graft subsequently requiring amputation. Amputation was needed in three other patients with technical failure, while a further patient had a successful repeat subintimal angioplasty. Conclusion: Subintimal angioplasty has an increasing role in limb salvage, particularly in patients unfit for operation. © 2001 British Journal of Surgery Society Ltd