The results of subintimal angioplasty in a district general hospital

Abstract

Objectives and Design: we report a prospective study to determine if subintimal angioplasty can be performed in non-teaching centres and to establish its learning curve. Materials and Methods: subintimal angioplasty was performed on 50 limbs in 46 patients (34 male) with a median age of 72 years (range 45–93 years). Indication was critical limb ischaemia (27 limbs) or intermittent claudication (23 limbs). Occlusions were located in the superficial femoral artery in 44 limbs, popliteal artery in 4 limbs and the peroneal artery in two limbs. At a median of 7.9 months patients had colour duplex imaging of the vessels that underwent angioplasty to assess vessel patency. Results: primary technical success was achieved in 39 cases (78%). Primary technical success was greater in the second group of 25 consecutive limbs to undergo angioplasty at 92% (23 cases) compared with the first 25 consecutive limbs at 64% (16 cases). At 6 months the overall vessel patency rate on duplex imaging was 57%, improving to 64% in the group having a primarily successful procedure. The equivalent rate of symptomatic improvement was 59 and 66% respectively. Complications occurred in five procedures, most were minor, but a single fatality was directly attributable to the procedure. Conclusion: subintimal angioplasty can reasonably be performed outside major teaching institutions. There is a short learning curve associated with the procedure.