The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Impact of subintimal angioplasty on treatment of critical leg ischaemia. BJS 2001; 88: 616-617.

Published: 6th December 2002

Authors: P. V. Tisi, A. Mirnezami, S. Baker, J. Tawn, S. D. Parvin, S. G. Darke et al.

Background

Distal bypass for critical leg ischaemia (CLI) is technically demanding and a physiological challenge to the patient. Angioplasty offers an attractive alternative, the application of which may be extended by subintimal techniques. This study reports on the immediate success of subintimal angioplasty and its impact on workload in this unit since the introduction of the technique in 1997.

Method

This was a retrospective review of a consecutive series of 166 legs (156 patients) with CLI treated by subintimal angioplasty from 1997 to 1999. Society for Vascular Surgery and International Society for Cardiovascular Surgery criteria were used to determine clinical status and patency.

Results

From 1997 to 1998 the rate of subintimal angioplasty increased, with a corresponding reduction in major amputation and surgery rates (P < 0·001, χ2 test). The increase in surgical reconstruction in 1999 could reflect delayed treatment of patients with late occlusion of a previously dilated segment.











1996
1997
1998
1999




Surgical reconstruction for CLI
104 (71·2)
104 (59·8)
70 (36·5)
114 (50·4)


Primary amputation
42 (28·8)
60 (34·5)
41 (21·4)
37 (16·4)


Subintimal angioplasty
0 (0)
10 (5·7)
81 (42·2)
75 (33·2)


Total
146
174
192
226






Values in parentheses are percentages

Conclusion

Subintimal angioplasty has an increasing role in limb salvage, particularly in patients unfit for operation. © 2001 British Journal of Surgery Society Ltd

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