Subintimal versus intraluminal recanalization of chronic iliac occlusions
Saim Yilmaz1, Timur Sindel, Ersin Lüleci
1Department of Radiology, Akdeniz University School of Medicine, Arapsuyu 07070, Antalya, Turkey. ysaim@akdeniz.edu.tr
Insights
Subintimal recanalization effectively treats chronic iliac occlusions when standard methods fail. The antegrade-retrograde approach yields better outcomes than the ipsilateral route for this endovascular technique.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Endovascular Therapy
Background:
- Chronic iliac occlusions pose treatment challenges.
- Standard intraluminal recanalization has limitations.
Purpose of the Study:
- To evaluate subintimal recanalization for chronic iliac occlusions.
- Compare subintimal with intraluminal recanalization outcomes.
Main Methods:
- Retrospective review of 98 patients with unilateral chronic iliac occlusions.
- Comparison of technical success, complications, and patency rates between intraluminal and subintimal recanalization.
- Subintimal recanalization used when intraluminal wire passage failed.
Main Results:
- Subintimal recanalization achieved 90% technical success in 39 patients.
- Intraluminal recanalization had 57% technical success in 98 patients.
- Primary and assisted primary patency rates were similar between techniques (p>0.05).
Conclusions:
- Subintimal recanalization is a safe and effective adjunct for chronic iliac occlusions.
- Antegrade-retrograde subintimal recanalization is preferred over the ipsilateral approach.
- This technique enhances endovascular treatment options for complex iliac lesions.
Purpose:
To present our experience with subintimal recanalization of chronic iliac occlusions and retrospectively compare the results of this technique with those of standard intraluminal recanalization.
Methods:
A retrospective review was conducted of 98 patients (91 men; mean age 61+/-10 years, range 37-77) with unilateral chronic iliac occlusions who underwent standard intraluminal recanalization or subintimal recanalization if intraluminal wire passage failed. The technical success, complications, and patency rates were statistically compared between groups.
Results:
In 59 (60%) of 98 patients, the occlusions were successfully crossed with ipsilateral intraluminal recanalization, while failure of intraluminal recanalization in the remaining 39 led to attempted subintimal recanalization (ipsilateral in 17 and antegrade-retrograde in 22). Overall, ipsilateral intraluminal recanalization was technically successful in 56 (57%) of 98 patients; subintimal recanalization was successful in 35 (90%) of 39 patients. Technical success was only 29% in 17 patients who underwent subintimal recanalization via an ipsilateral retrograde approach. During a follow of 27+/-16 months, primary and assisted primary patencies were not significantly different between the patients treated with intraluminal versus subintimal recanalization (p=0.81 and 0.64, respectively).
Conclusions:
Subintimal recanalization is a safe and effective supplement to standard intraluminal recanalization techniques in the endovascular treatment of chronic iliac occlusions. Because of the poor outcome associated with the ipsilateral route, subintimal recanalization of these lesions should preferably be performed via a combined antegrade-retrograde approach.
Related Concept Videos
01:26Aneurysm III: Interprofessional Care
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD: