Roberto Gandini MD, Abstract Co-Author: Nothing to Disclose

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

Alessio Spinelli MD, Abstract Co-Author: Nothing to Disclose

Sergio Spano MD, Presenter: Nothing to Disclose

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

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

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

398 patients with a SFA occlusion, enrolled in our study, were treated by subintimal angioplasty, with or without stenting with an omolateral antegrade approach. Subintimal stent was released only following these indications:  1) Slow flow after SIA 2) Focal stenosis due to heavy wall calcifications 3) Complete obstruction after angioplasty 4) A 90°degree re-entry angle due to assisted re-entry devices Patency and treatment of stet occlusion were analized considering the position of stent in the subintimal channel Patient history, demographics, procedural details, and follow-up information were collected and analyzed. Patency, limb salvage and survival were determined by Kaplan-Meier analysis.

SIA was successful in 398 patients of 406 critically limb ischemia (98%). Stents were released in the subintimal channel in 83 patients (21%) after suboptimal SIA. Primary patency at one year follow-up was 79.5% and 66.7% respectively in patients treated with and without stent (p=0.02). 1 year follow-up secondary patency was 87.5% and 92.0% 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 and popliteal artery lesions. 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 work underline usefulness of stenting with subintimal technique and management of secondary occlusion focusing on importance of stent position in the subintimal channel.

Gandini, R, Pampana, E, Spinelli, A, Spano, S, Del Giudice, C, Simonetti, G, Subintimal Angioplasty for Superficial Femoral Artery TASC IID Lesions in Critical Limb Ischemia: Outcomes with and without Stenting and Value of Stent Position for Secondary Patency after Subintimal Channel Occlusion.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9014420.html