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Efficacy of subintimal angioplasty/stent implantation for long, multisegmental lower limb occlusive lesions in patients unsuitable for surgery

 Jung-Sun Kim  ;  Tae Soo Kang  ;  Chul Min Ahn  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Yangsoo Jang  ;  Namsik Chung  ;  Won-Heum Shim  ;  Seung-Yun Cho 
 JOURNAL OF ENDOVASCULAR THERAPY, Vol.13(4) : 514-521, 2006 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Angioplasty, Balloon* ; Arterial Occlusive Diseases/diagnostic imaging ; Arterial Occlusive Diseases/therapy* ; Disease-Free Survival ; Feasibility Studies ; Female ; Femoral Artery/diagnostic imaging ; Follow-Up Studies ; Humans ; Iliac Artery/diagnostic imaging ; Limb Salvage/methods ; Male ; Middle Aged ; Popliteal Artery ; Radiography ; Retrospective Studies ; Stents* ; Tibial Arteries ; Treatment Outcome ; Tunica Intima
subintimal angioplasty ; lower limb artery ; occlusion ; femoropopliteal segment ; tibioperoneal arteries ; superficial femoral artery
Purpose: To investigate the feasibility and clinical outcomes of subintimal angioplasty combined with stent implantation in patients with long, multisegmental occlusive lesions unsuitable for surgical treatment. Methods: Between 2003 and 2005, 30 patients (23 men; mean age 68 years, range 49–82) with severe claudication (Rutherford category 3, n=12) or critical limb ischemia (CLI; Rutherford category 4 or 5, n=18) underwent subintimal angioplasty with primary stenting for long (mean 28±11 cm) total occlusion in the lower limb arteries. Bypass surgery was considered unsuitable owing to inappropriate anatomy or poor distal runoff in 14 (47%) patients, severe coronary artery disease 14 (47%), or poor general condition in 2 (6%). Results: Technical success was achieved in 27 (90%) of 30 cases. The 3 technical failures were due to inability to advance the wire, to re-enter the distal lumen, and vessel rupture, respectively. Three (10%) complications occurred (1 perforation, 2 hematomas) but did not require surgery. After a mean follow-up of 13±7 months (range 3–28), 10 (37%) cases of restenosis were found in 27 patients. At 12 months, the primary patency rate was 52%, and the limb salvage rate was 83%. Conclusion: Combined use of subintimal angioplasty and stent implantation was performed safely, with a relatively high success rate and acceptable intermediate-term clinical outcomes in patients with multisegmental, long occlusions of the lower limb arteries. Therefore, this strategy can be considered an option for symptomatic relief and limb salvage in patients unsuitable for bypass surgery due to various reasons.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Shim, Won Heum(심원흠)
Ahn, Chul-Min(안철민) ORCID logo https://orcid.org/0000-0002-7071-4370
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Chung, Nam Sik(정남식)
Cho, Seung Yun(조승연)
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
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