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Midterm Outcomes of Subintimal Angioplasty Supported by Primary Proximal Stenting for Chronic Total Occlusion of the Superficial Femoral Artery

 Sung-Jin Hong  ;  Young-Guk Ko  ;  Jung-Sun Kim  ;  Myeong-Ki Hong  ;  Yangsoo Jang  ;  Donghoon Choi 
 JOURNAL OF ENDOVASCULAR THERAPY, Vol.20(6) : 782-791, 2013 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Angioplasty, Balloon/adverse effects ; Angioplasty, Balloon/instrumentation* ; Ankle Brachial Index ; Body Mass Index ; Chronic Disease ; Constriction, Pathologic ; Female ; Femoral Artery*/diagnostic imaging ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Peripheral Arterial Disease/diagnosis ; Peripheral Arterial Disease/therapy* ; Proportional Hazards Models ; Radiography ; Recurrence ; Registries ; Retrospective Studies ; Risk Factors ; Stents* ; Time Factors ; Treatment Outcome
subintimal angioplasty ; peripheral occlusive disease ; superficial femoral artery ; chronic total occlusion ; critical limb ischemia ; stent ; primary stenting ; intimal flap ; restenosis ; target lesion revascularization
Purpose: To investigate the midterm outcomes of subintimal angioplasty in occluded superficial femoral arteries (SFA) and evaluate the clinical and procedural factors affecting these results. Methods: Between April 2004 and April 2012, 150 patients (122 men; mean age 69±10 years) with chronic total occlusions in the SFA underwent subintimal angioplasty with primary stenting in 172 limbs. The average lesion length was 22.6±8.5 cm. Stents were routinely implanted at the proximal entry into the subintimal channel. The primary endpoint was binary restenosis. Results: Technical success was achieved in 161 (94%) limbs; there were no procedure-related deaths or complications requiring surgery, but distal embolization and arterial perforation occurred in 2 and 4 limbs, respectively. The cumulative freedom from binary restenosis rates at 1 and 3 years were 77% and 59%, respectively, in the entire study group. The 96 patients without critical limb ischemia (CLI) had significantly higher patency rates at 1 and 3 years (84% and 66%, respectively) than the 54 patients with CLI (66% and 43%, respectively; p=0.011). Based on multivariate analysis, a larger number of stents, lower post-procedure ankle-brachial index, and lower body mass index were each independent predictors of binary restenosis. Conclusion: Subintimal angioplasty with routine stenting at the proximal stump is safe and effective for the treatment of chronic total SFA occlusions.
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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
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
Hong, Sung Jin(홍성진) ORCID logo https://orcid.org/0000-0003-4893-039X
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