Role of subintimal angioplasty in the treatment of chronic lower limb ischaemia.

Objectives: To determine the clinical outcome of subintimal angioplasty (SA) and to assess impact on surgical workload.

Design: Retrospective review of a single radiologist's case series.

Materials: One hundred and twenty two patients with critical limb ischaemia and 26 with claudication.

Methods: One hundred and fifty eight limbs treated by SA.

Main Outcome Measures: Technical success and complications; cumulative patency, limb salvage and survival; affect of SA on vascular workload.

Results: The technical success rate was 85%. There were 26 procedural complications (16%) but no patient required emergency surgery; 30-day mortality was 3%. Primary and secondary 12-month patency rates were 27 and 33%. Limb salvage rate was 88% at 12 months. SA initially reduced the number of patients needing arterial surgery, although this then increased due to late failure of SA and an increase in de novo bypass.

Conclusions: SA carries a low risk of major complications and high immediate technical success. Poor long-term patency suggests that SA is not as durable as bypass surgery. However, failed SA did not compromise subsequent surgery, which only became necessary in a proportion of patients. Our data suggests that there is little to be lost by using SA as first-line treatment for patients with limb-threatening ischaemia who are poor operative risks or who have no autologous vein available.