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Published on: September 22, 2020
The results of subintimal angioplasty in a district general hospital
M B K Shaw1, M DeNunzio, D Hinwood
1Department of Surgery, Derbyshire Royal Infirmary, London Road, Derby, UK.
Objectives And Design:
we report a prospective study to determine if subintimal angioplasty can be performed in non-teaching centres and to establish its learning curve.
Materials And Methods:
subintimal angioplasty was performed on 50 limbs in 46 patients (34 male) with a median age of 72 years (range 45-93 years). Indication was critical limb ischaemia (27 limbs) or intermittent claudication (23 limbs). Occlusions were located in the superficial femoral artery in 44 limbs, popliteal artery in 4 limbs and the peroneal artery in two limbs. At a median of 7.9 months patients had colour duplex imaging of the vessels that underwent angioplasty to assess vessel patency.
Results:
primary technical success was achieved in 39 cases (78%). Primary technical success was greater in the second group of 25 consecutive limbs to undergo angioplasty at 92% (23 cases) compared with the first 25 consecutive limbs at 64% (16 cases). At 6 months the overall vessel patency rate on duplex imaging was 57%, improving to 64% in the group having a primarily successful procedure. The equivalent rate of symptomatic improvement was 59 and 66% respectively. Complications occurred in five procedures, most were minor, but a single fatality was directly attributable to the procedure.
Conclusion:
subintimal angioplasty can reasonably be performed outside major teaching institutions. There is a short learning curve associated with the procedure.
