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Subintimal angioplasty of infrainguinal arterial occlusions for critical limb ischemia: Long-term patency and clinical efficacy

Åkesson, Michael LU ; Riva, Lorenzo; Ivancev, Krassi LU ; Uher, Petr LU ; Lundell, Anders LU and Malina, Martin LU (2007) In Journal of Endovascular Therapy 14(4). p.444-451
Abstract
Purpose: To evaluate long-term patency and clinical efficacy of subintimal angioplasty (SAP) of occluded infrainguinal arteries 3 years post procedure. Methods: One hundred eighty-one patients (92 men; median age 79 years) underwent attempted SAP in 193 limbs with occluded infrainguinal arteries during the period 1999 to 2001. Nearly half (83, 46%) of the patients had diabetes. Most (172, 95%) had critical ischemia (Fontaine classification >II). All patients surviving at least 3 years after the procedures were followed in January 2005 with questionnaires, clinical examinations, ankle-brachial index measurements, and duplex ultrasonography. All data were collected prospectively and analyzed retrospectively. Results: The primary technical... (More)
Purpose: To evaluate long-term patency and clinical efficacy of subintimal angioplasty (SAP) of occluded infrainguinal arteries 3 years post procedure. Methods: One hundred eighty-one patients (92 men; median age 79 years) underwent attempted SAP in 193 limbs with occluded infrainguinal arteries during the period 1999 to 2001. Nearly half (83, 46%) of the patients had diabetes. Most (172, 95%) had critical ischemia (Fontaine classification >II). All patients surviving at least 3 years after the procedures were followed in January 2005 with questionnaires, clinical examinations, ankle-brachial index measurements, and duplex ultrasonography. All data were collected prospectively and analyzed retrospectively. Results: The primary technical success in the entire cohort was 77% (148/193). Thirty-day mortality was 10% (19/181); 113 (62%) patients died before the 3-year follow-up. In the 68 (38%) survivors (71 limbs), patency at 49.2 months (IQR 40.8-57.6) was 40% (26/65 limbs imaged by duplex). The TASC classification did not affect technical or clinical outcomes. Forty-six (68%) of the survivors presented with clinical improvement (lower Fontaine classification at postoperative follow-up versus baseline). The limb salvage at >3 years was 86% in the 58 primarily successful SAPs and 38% in the 13 procedures that failed initially. Conclusion: SAP is a minimally invasive option for patients with critical limb ischemia. A primary technical success is essential for good clinical outcome and primary technical failure is more devastating than late occlusion. TASC classification and length of the SAP are of poor predictive value. More data are needed to confirm the efficacy of SAP. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
critical, limb ischemia, subintimal angioplasty, infrainguinal arterial occlusions
in
Journal of Endovascular Therapy
volume
14
issue
4
pages
444 - 451
publisher
International Society of Endovascular Specialists
external identifiers
  • wos:000248794300003
  • scopus:34848851422
ISSN
1545-1550
DOI
10.1583/1545-1550(2007)14[444:SAOIAO]2.0.CO;2
language
English
LU publication?
yes
id
91f6d2cd-bff5-4bc5-8d91-97bbd799630f (old id 691733)
date added to LUP
2007-12-11 13:40:07
date last changed
2017-01-01 04:23:01
@article{91f6d2cd-bff5-4bc5-8d91-97bbd799630f,
  abstract     = {Purpose: To evaluate long-term patency and clinical efficacy of subintimal angioplasty (SAP) of occluded infrainguinal arteries 3 years post procedure. Methods: One hundred eighty-one patients (92 men; median age 79 years) underwent attempted SAP in 193 limbs with occluded infrainguinal arteries during the period 1999 to 2001. Nearly half (83, 46%) of the patients had diabetes. Most (172, 95%) had critical ischemia (Fontaine classification >II). All patients surviving at least 3 years after the procedures were followed in January 2005 with questionnaires, clinical examinations, ankle-brachial index measurements, and duplex ultrasonography. All data were collected prospectively and analyzed retrospectively. Results: The primary technical success in the entire cohort was 77% (148/193). Thirty-day mortality was 10% (19/181); 113 (62%) patients died before the 3-year follow-up. In the 68 (38%) survivors (71 limbs), patency at 49.2 months (IQR 40.8-57.6) was 40% (26/65 limbs imaged by duplex). The TASC classification did not affect technical or clinical outcomes. Forty-six (68%) of the survivors presented with clinical improvement (lower Fontaine classification at postoperative follow-up versus baseline). The limb salvage at >3 years was 86% in the 58 primarily successful SAPs and 38% in the 13 procedures that failed initially. Conclusion: SAP is a minimally invasive option for patients with critical limb ischemia. A primary technical success is essential for good clinical outcome and primary technical failure is more devastating than late occlusion. TASC classification and length of the SAP are of poor predictive value. More data are needed to confirm the efficacy of SAP.},
  author       = {Åkesson, Michael and Riva, Lorenzo and Ivancev, Krassi and Uher, Petr and Lundell, Anders and Malina, Martin},
  issn         = {1545-1550},
  keyword      = {critical,limb ischemia,subintimal angioplasty,infrainguinal arterial occlusions},
  language     = {eng},
  number       = {4},
  pages        = {444--451},
  publisher    = {International Society of Endovascular Specialists},
  series       = {Journal of Endovascular Therapy},
  title        = {Subintimal angioplasty of infrainguinal arterial occlusions for critical limb ischemia: Long-term patency and clinical efficacy},
  url          = {http://dx.doi.org/10.1583/1545-1550(2007)14[444:SAOIAO]2.0.CO;2},
  volume       = {14},
  year         = {2007},
}