[Subintimal recanalization. Indications, technique and results].

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Endovascular Interventions

Background:

• Endovascular interventions aim to restore blood flow in lower extremities.
• Subintimal recanalization is a crucial alternative for chronic total occlusions (CTOs) when endoluminal recanalization is not feasible.
• This technique intentionally creates a channel in the vessel wall to bypass occlusions.

Purpose of the Study:

• To provide an overview of the significance of subintimal recanalization in the lower extremities.
• To discuss the evolution and effectiveness of subintimal recanalization techniques.

Main Methods:

• Review of subintimal recanalization techniques for lower extremity arterial disease.
• Comparison of conventional catheter and wire methods with newer re-entry devices.
• Analysis of technical success rates and failure modes, particularly re-entry challenges.

Main Results:

• Technical success rates for subintimal recanalization of CTOs range from 65-100%.
• Technical failure, often due to re-entry difficulties, occurs in about 25% of cases with conventional methods.
• Re-entry devices have improved technical success, reduced complications and procedure time, but increase costs.

Conclusions:

• Subintimal recanalization offers a high technical success rate for treating high-grade stenoses and CTOs in the lower extremities.
• Both conventional and device-assisted techniques require experienced physicians skilled in managing complex materials and complications.
• The choice of technique depends on physician expertise, available resources, and patient-specific factors.