Role of subintimal angioplasty in the treatment of chronic lower limb ischaemia.

Abstract

To determine the clinical outcome of subintimal angioplasty (SA) and to assess impact on surgical workload. Retrospective review of a single radiologist's case series. One hundred and twenty two patients with critical limb ischaemia and 26 with claudication. One hundred and fifty eight limbs treated by SA. Technical success and complications; cumulative patency, limb salvage and survival; affect of SA on vascular workload. 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. 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.