Transluminal versus Subintimal Angioplasty for Management of Critical Limb Ischemia Patients with Femoropopliteal Occlusive Disease

Abstract

Aim Comparison between intraluminal and subintimal angioplasty with review of technique, factors affecting the success and complications with special emphasis on factors that could predict the wire route meanwhile using simple techniques. Methods This is a non-randomized study with prospectively collected data that included 159 patients presented from 2011 to 2014 to the vascular surgery department with critical chronic lower limb ischemia due to atherosclerotic femoropopliteal occlusive disease for whom percutaneous angioplasty was done. Patients presenting with nonsalvageable limbs requiring primary major amputation and non-atherosclerotic causes of CLI were excluded. Results 75.5% of the lesionswere crossed transluminally while 19.5% of the lesions were crossed subintimally. In 8 cases (5%) the lesion could not be passed. The overall technical success to pass the lesion was 95%. On 24 months follow up, 1ry patency, 2ry patency, limb salvage in intraluminal group are 56.8%, 60.2% and 66.1% respectively while in subintimal group 46.7%, 46.7% and 60% respectively. Subintimal was more in the TASC D, lesion more than 10 cm and in contralateral access (P value was<0.05). There were no statistically significant differences between intraluminal and subintimal angioplasty regarding the outcome (Patency and limb salvage). Conclusions The passage of the wire is affected by length of the lesion, the TASC II classification of the lesion and access site with the subintimal passage was more in Lesion more than 10 cm, TASC D lesions and in contralateral access. These factors can be used prospectively as predictors for passage of the wire whether intraluminal or subintimal. In spite of the technical differences between the intraluminal and subintimal passage, yet they show no significant statistical differences regarding the outcome (patency and limb salvage). Hence both should be used as part of vascular armamentarium for revascularization in such frail patients.