Ces radiol. 2008, 62(2):153-159

Subintimal angioplasty in femoropopliteal region - mid-term resultsOriginal article

Martin Kócher¹, Marie Černá¹, Petr Utíkal², Jiří Kozák¹, Ivan Šišola¹, Petr Bachleda², Petr Dráč², Zdeněk Sekanina², Kateřina Langová³

¹ Radiologická klinika LF a FN, Olomouc

² II. chirurgická klinika LF a FN, Olomouc

³ Ústav lékařské biofyziky LF UP, Olomouc

Aim: Subintimal angioplasty is becoming more frequently used treatment option for patients with long arterial occlusions or diffuse atherosclerotic changes as an alternative to surgical treatment in claudicants and especially in patients with critical limb ischemia.
The aim of our article is to retrospectively assess mid-term outcomes of subintimal angioplasty of chronic arterial occlusions in femoropopliteal region followed clinically and by doppler ultrasonography.

Methods: From May 2002 to December 2007, 133 femoropopliteal artery occlusions in 123 patients were indicated for subintimal recanalisation. The indications for treatment were intermittent claudications in 84 patients (63.15 %) and critical limb ischemia in 49 patients (36.85 %). The median length of lesions was 11.4 cm, range 2 to 30 cm. Except doppler ultrasonographic examination done 24 hours after the procedure and clinical examination before discharge, both clinical and ultrasonographic examinations were performed 6 and 12 months after the procedure and yearly thereafter. Statistical analysis of our cohort was performed by Kaplan-Meier analysis, log-rank test and Cox regresion.

Results: Technical success was achieved in 86,46 %. Primary patency rate was 83.1 % (SE: 3.9 %), 67.5 % (SE: 5 %), 58 % (SE: 5.9 %) a 48.4 % (SE: 7.1 %) at 6, 12, 24 and 36 months respectively. No statistically significant difference of primary patency was found between the group of claudicants and the group of patient with critical limb ischemia. Statisticaly significant prediction factors for primary patency was only the quality of the run offand the length of the occlusion. Limb salvage rate in our group of patients with critical limb ischemia was 80.8 % at 12 months.

Conclusion: Subintimal recanalisation is a simple and safe procedure for treatment of chronic peripheral arterial occlusions with high primary technical success rate, acceptable primary patency rate, low percentage of complications and mortality is as low as nil. Subintimal angioplasty is definitely advantageous and fast method in patients with critical limb ischemia with high possibility of limb salvage. Surgical treatment can be replaced by subintimal angioplasty in claudicants with high risk of operative treatment, without suitable autologous vein graft or where distal femoropopliteal or femorocrural bypass is needed.

Keywords: subintimal recanalisation, angioplasty, femoropopliteal occlusion

Accepted: March 31, 2008; Published: June 1, 2008  Show citation