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
Successful subintimal angioplasty for leg ischaemia is dependent on length of occlusion, not site of lesion. BJS 2001; 88: 616-616.
Published: 6th December 2002
Authors: J. R. Boyle, D. Perry, N. Gonem, A. R. Cowan, G. L. Sutton, R. M. Pemberton et al.
Background
The development of subintimal angioplasty offers an endovascular approach to the treatment of long occlusions not suitable for conventional transluminal angioplasty; it remains, however, the remit of relatively few radiologists in specialist centres. The authors have adopted the technique in view of promising published results.
Method
Between May 1997 and July 2000, 50 patients had attempted subintimal angioplasty (median age 71 (interquartile range (i.q.r.) 61–80) years). Patients were divided into two groups by length of occlusion; 26 patients (group 1) had occlusions greater than 10 cm in length (iliac, one; superficial femory artery (SFA), 24; crural, one) and 24 patients (group 2) had occlusions of less than 10 cm (iliac, five; SFA, five; popliteal, nine; crural, five). The primary technical success rate, ankle: brachial pressure index (ABPI) before and after the procedure, complication rate and symptomatic improvement were recorded for both groups.
Results
The groups were well matched for age and indication for intervention. Primary technical success was significantly better for occlusions of less than 10 cm than for the longer lesions (83 versus 50 per cent; P < 0·01) with corresponding significantly greater rises in ABPI (P < 0·05). Complications included one death in each group, one amputation in group 2 and six in group 1, all after failed salvage grafts. χ2test;
Conclusion
Subintimal angioplasty gives excellent results for occlusions of less than 10 cm in length irrespective of arterial site. Results for longer lesions are poor, with failed subintimal angioplasty often precipitating urgent distal vascular reconstruction and associated high risk of major amputation. © 2001 British Journal of Surgery Society Ltd
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