Role of Subintimal Angioplasty in the Treatment of Chronic Lower Limb Ischaemia

Abstract

Objectives: to determine the clinical outcome of subintimal angioplasty (SA) and to assess impact on surgical workload. Design: retrospective review of a single radiologist's case series. Materials: one hundred and twenty two patients with critical limb ischaemia and 26 with claudication. Methods: one hundred and fifty eight limbs treated by SA. Main outcome measures: technical success and complications; cumulative patency, limb salvage and survival; affect of SA on vascular workload. Results: the technical success rate was 85%. There were 26 procedural complications (16%) but no patient required emergency surgery; 30-day mortality was 3%. Primary and secondary 12-month patency rates were 27 and 33%. Limb salvage rate was 88% at 12 months. SA initially reduced the number of patients needing arterial surgery, although this then increased due to late failure of SA and an increase in de novo bypass. Conclusions: SA carries a low risk of major complications and high immediate technical success. Poor long-term patency suggests that SA is not as durable as bypass surgery. However, failed SA did not compromise subsequent surgery, which only became necessary in a proportion of patients. Our data suggests that there is little to be lost by using SA as first-line treatment for patients with limb-threatening ischaemia who are poor operative risks or who have no autologous vein available.