A Report Of Subintimal Angioplasty In The Treatment Of Atherosclerosis Obliterans In The Lower Extremity

Objective To report the methode of subintimal angioplasty for treatment of atherosclerosis obliterans(ASO) in the lower extremity and its clinical effectiveness.Methods:From September 2006 to September 2007,we treated 12 patients(totally 12 limbs) with ASO in the lower extremity by subintimal angioplasty (SIA).Patients were placed in supine position.Under local anesthesia,the procedure was started with an antegrade or retrograde puncture of the ipsilateral femoral artery.After the placement of a 6-F catheter,under fluoroscopic control,guided by an 0.035-inch-diameter stiff guide wire,a 4F KMP catheter was advanced towards the lesion by a subintimal route.When the distal part of the occluded segment was reached,the catheter tip was turned intraluminally to let the guide wire enter into the lumen.Withdraw the catheter,a suitable balloon catheter was passed over the wire.Then neolumen created was dilated under a pressure of 709～811kPa.Then performed an arteriogram and placed stent appropriate in size to the occluded arteries if necessary.The patients were rechecked ABI index and followed for long terms to evaluate its shortterm clinical effectiveness.Results:Technical success was achieved in 11(91.7%) of 12 limbs.All the patients had no severe complications,such as perforation of the artery,just lpatient with the subcutaneously hematoma.The preoperative ABI index were 0.14～0.43(means 0.28),and post operative ABI index were 0.25～1.08(means 0.82)(P＜0.01).Followed for 1～12 monthes(means 6 monthes),one patient was amputated extremity one week after SIA because of thrombopoiesis in the second day,and one was amputated extremity 8 monthes later, the others remained patent.Conclusion:SIA is a new methode for the treatment of ASO in the lower extremities,and safe,mini-invasive,easy to handle,with satisfactory shortterm effect.But as a new technique,there is lots of questions need to study and research..