Clinical Research On Subintimal Angioplasty For Long-segment Total Occlusion Of Superficial Femoral Artery

Objective: To evaluate long-term results of subintimal angioplasty forlong-segment totalocclusion of superficial femoral artery.Method: These figures are based on the retrospective analysis of99cases(109legs) with long-segment total occlusion of superficial femoral artery TASC D or TASCC from March2008to December2008treated in our center. Mean age is74±8.1years (range,55-92years),60cases of men, women,39. Limb ischemia in patients withpreoperative Fontaine staging evaluation was recorded. To assess extent of the limbischemia, we calculate the Ankle Brachial Index (ABI), Ultrasound, CTA, NCMRA. Ofthe109legs,63legs was TASC C,46legs TASC D.10legs was Fontaine IIb,38legs Fontaine III,61legs Fontaine IV.The mean ABI before operation is0.43±0.12. The subintimal angioplasty is performed with Admiral balloon,AMDballoon or Reekross balloon and the arterial lesion covered with bare metal stent. Afterthe subintimal angioplasty, all the broken feet would be treated with regular localdebridement therapy. The methods of evaluation of therapeutic efficiency areABI immediate post-surgical fitting, the concrescence condition of the broken legspostoperative1month,6months,1year and3years and lower limb vascularevaluations by Ultrasound, CTA, NCMRA and presence of amputation or not.Results:109superficial femoral arteries were successfully opened in the wholeblock section by SIA technology, surgical success rate was100%(109/109), themean postoperative ABI:0.88±0.21,ischemic symptoms is significantly improved,(p＜0.05). Among61legs with burst gangrene (61/109),59legs healed, with the rate92%（59/61）.The mean time of healing was6months. Limb preservation ratewere98%(postoperative1year)、94%(postoperative3years)and88%(postoperative5years), respectively. Up-studies,1month,6months,1year and3years, a period of patency rate was94%(101/107),89%(85/95),68%(47/69),28%(12/43), thesecondary patency rate was99%(106/107),96%(91/95),78%(54/69),35%(15/43).There were no operation related complications such as arteriorrhexis or embolization.Conclusion: The subintimal angioplasty is a good method for long-segment totalocclusion of superficial femoral artery. It is safe, efficient, repeatable with a hightechnical success rate. The subintimal angioplasty can be regarded as the preferredprocedure to long-segment total occlusion of superficial femoral artery, especiallyfor CLI.