Subintimal angioplasty: feasible and durable

To assess prospectively the feasibility and durability of subintimal angioplasty (SA) clinically and by duplex scans every 3 months.

Within a period of 54 months, we selected 96 patients with 100 occlusions (mean length: 11.5 cm) of femoro-popliteal or tibial arteries, for SA.

The technical success rate was 88% and seven out of 12 failures were treated by conventional surgery. Five below-the-knee amputations were performed despite a patent recanalization. The following complications occurred: arterial perforation (6), arterial thrombosis (4), extensions beyond the planned re-entry site (5), and arterial dissection (2). Primary, assisted-primary and secondary patency rates were 61, 68 and 74%, respectively at 24 months. The 24 month-limb salvage and survival rates were 78 and 85%, respectively. Duplex imaging demonstrated 10 restenosis (five symptomatic >70%, five asymptomatic 30-70%), seven occlusions (five asymptomatic, two symptomatic treated by a bypass) and one asymptomatic dilatation.

In a selected group of patients SA is feasible with a high initial technical success rate. SA is a good alternative in patients who are poor candidates for bypass surgery.