Roberto Gandini MD, Presenter: Nothing to Disclose

Enrico Pampana MD, Abstract Co-Author: Nothing to Disclose

Massimiliano Di Primio MD, Abstract Co-Author: Nothing to Disclose

Costantino Del Giudice MD, Abstract Co-Author: Nothing to Disclose

Valerio Da Ros, Abstract Co-Author: Nothing to Disclose

Giovanni Simonetti MD, Abstract Co-Author: Nothing to Disclose

In a prospective, non randomized, single center consecutive series of subintimal angioplasty (SIA) for superficial femoral artery TASC II D lesions, critical limb ischemia patients’ data were analyzed with regard to immediate outcome and follow-up success.

From February 2005 to December 2007 406 patients with critical limb ischemia underwent primary SIA for superficial femoral artery obstruction. Our analysis included all patients with ulcers and/or rest pain (Rutherford class IV - VI) and SFA TASC II D lesions treated with SIA as primary choice, associated to stent deployment only in case of unsuccessful and/or unsatisfactory angioplasty. Clinical follow-up was performed at 3 months, 6 months, and 12 months after the procedure. The examination included measurement of the ankle–brachial index and color duplex ultrasonography. In case of recurrence of steno-obstructions our patients underwent to an angio-magnetic resonance or CT scan evaluation to plan a new procedure.  

SIA was successful in 398 patients of 406 critically limb ischemia (98%). Stents were released in the subintimal channel in 83 patients (21%). Primary patency at one year follow-up was 66.7% and 79.5% respectively in patients treated with and without stent (p=0.02). 1 year follow-up secondary patency was 88.2% and 92.1% in patients treated with and without stent (p=NS). Re-occlusions occurred in 147 patients treated by SIA alone (47%) and 27 patients treated by SIA and stent (32%) (p=0.02). Successful recanalization rate was higher for patients treated by SIA alone (95%) compared to patients in who a stent was released (81%) (p=0.04). Feasibility of stent recanalization was higher in patients treated by a stent released in contact with the true lumen (p=0.02)  

SIA is a feasible and effective primary treatment for patient with critical limb ischemia due to a TASC II D superficial femoral artery lesion. Use of stent in subintimal angioplasty improve primary patency compared to SIA alone treatment. Stent position affects the technical approach for possible future recanalization after stent occlusion.

This study evaluates the role of primary subintimal angioplasty for TASC II D lesions of superficial femoral artery, focusing on stent use and its role on treatment of secondary occlusions.

Gandini, R, Pampana, E, Di Primio, M, Del Giudice, C, Da Ros, V, Simonetti, G, Subintimal Angioplasty for Superficial Femoral Artery TASC II D Lesions in Chronic Limb Ischemia: Outcomes with and without Stenting and Value of Stent Position for Secondary Patency after Subintimal Channel Occlusion.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8012558.html