Subintimal angioplasty of chronic total superficial femoral artery occlusions in critical lower limb ischemia patients: the single center experience

Objective
The aim of this article was to report our results of subintimal angioplasty (SIA) of long superficial femoral artery (SFA) occlusions and try to appreciate factors that affect patency following this type of intervention in critical lower limb ischemia (CLI) patients.
Patients and methods
The current series was conducted prospectively over a 1-year period. Forty cases, 40 limbs (mean age = 65.8 years old) with long SFA occlusion (>15 cm) and patent popliteal artery continuous with at least one leg artery runoff were included. Exclusion criteria were: renal impairment, nonatherosclerotic occlusions (thrombosis, dissection, or compression), short SFA occlusions (<15 cm), or non-SIA revascularization intervention. Results were considered successful with primary technical success combined with improving ischemic rest pain or healing wounds following minor amputations. Nonrecanalization or major amputations were considered failures. One-year patency and salvage rates were calculated. Factors that affected patency such as patent leg arteries and TASC grading were analyzed.
Results
Results were considered successful in 34 (85%) patients and failure was noticed in six (15%) cases. At the end of the first follow-up year, the primary patency rate was 75% and the salvage rate was 87.5%. The 1-year patency rate was higher in TASC C patients (85.7%) in comparison with TASC D cases (69.2%). The patency rate was 50% or less with one patent leg artery and 80% or more with two or three patent leg arteries.
Conclusion
SIA is a good alternative for recanalization of chronic long SFA total occlusions in CLI patients with acceptable 1-year patency rates. Number of patent leg arteries is an important determinant of durable procedures.