Subintimal angioplasty for long (TASC C and D) superficial femoral artery occlusions

Abstract

Sub-intimal angioplasty (SIA) is a recognized endovascular option for long segment occlusive disease. The Inter-Society Consensus for the Management of peripheral arterial disease (TASC) published a revised classification for infra-inguinal peripheral vascular disease in 2007. We present our experience with this technique and aim to determine the efficacy of sub-intimal angioplasty (SIA) for TASC C and TASC D category lesions. Materials and MethodsA retrospective analysis of all consecutive SIA for TASC C and D superficial femoral artery (SFA) occlusions was conducted. The procedures were carried out in a single center between 01/11/2009 and 01/06/2011. Primary endpoints were limb salvage rates. Secondary endpoints were primary, primary assisted, secondary patency, and complication rates. Kaplan–Meier analysis was used to assess the patency, limb salvage and survival rates. Results29 limbs in 26 patients were treated, median age 69years. Indications included moderate to severe claudication in 18 limbs and critical limb ischemia (CLI) in 11 limbs. There were six TASC C and 23 TASC D lesions with a median lesion length of lesion 27.3cm (15.2–46.4). Complications occurred in 3 cases (10%), which were all distal embolization. All 3 had successful thrombo-aspirations and were treated with IV heparin for 24–48h. The technical and clinical success rates were 93.1%. The primary patency rate, primary assisted patency and secondary patency at 1year of approximately were 41%, 57% and 60% respectively. There was one below knee amputation in the study group, giving a cumulative proportional limb salvage rate of 96.6%. The primary patency of the CLI group was 60% at 1year. ConclusionAlthough we observed a low primary patency rate there were encouraging limb salvage rates in patients with TASC C and D lesions treated with SIA. It provides an alternative to surgery in high risk patients, with acceptable technical success and complication rates but re-intervention is likely to be required.