Subintimal Angioplasty as a Primary Modality in the Management of Critical Limb Ischemia: Comparison to Bypass Grafting for Aortoiliac and Femoropopliteal Occlusive Disease

Purpose: To compare the 30-day morbidity, mortality, length of hospital stay, and patency rates in patients with critically ischemic limbs treated with subintimal angioplasty (SA) versus standard bypass surgery. Method: Between October 2001 and August 2003, 137 patients (74 women; mean age 70 years,...

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Bibliographic Details
Published in:Journal of endovascular therapy 2004-08, Vol.11 (4), p.460-471
Main Authors: Hynes, Niamh, Akhtar, Yousaf, Manning, Brian, Aremu, Muyiwa, Oiakhinan, Kenneth, Courtney, Donald, Sultan, Sherif
Format: Article
Language:English
Subjects:
Aged
Angioplasty - adverse effects
Arteriosclerosis - complications
Arteriosclerosis - surgery
Female
Follow-Up Studies
Humans
Ischemia - etiology
Ischemia - surgery
Leg - blood supply
Leg - surgery
Length of Stay
Male
Middle Aged
Reperfusion - adverse effects
Survival Rate
Treatment Outcome
Vascular Patency
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Summary:Purpose: To compare the 30-day morbidity, mortality, length of hospital stay, and patency rates in patients with critically ischemic limbs treated with subintimal angioplasty (SA) versus standard bypass surgery. Method: Between October 2001 and August 2003, 137 patients (74 women; mean age 70 years, range 43–92) with critical limb ischemia underwent subintimal angioplasty (n=88) or bypass surgery (n=49) for superficial femoral artery (SFA) or aortoiliac lesions. All patients had lesions classified as C or D according to the TransAtlantic Inter-Society Consensus. Data was retrieved from hospital inpatient inquiry and VascuBase. Parallel group comparison was used in performing a prospective observational study. Results: Primary technical success was 100% for both SA and bypass grafting. Thirty-day survival was 100% in the SFA-SA and aortoiliac bypass groups and 96% and 93%, respectively, in the SFA bypass and aortoiliac SA groups. Limb salvage was 97% and 82% in the SFA-SA and SFA bypass groups, respectively; at the aortoiliac levels, the rates were 100% and 86% for SA versus bypass. Subintimal angioplasty significantly reduced hospital stay (p
ISSN:1526-6028
1545-1550
DOI:10.1583/04-1242.1