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CardioVascular and Interventional Radiology

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Open Access 01-07-2008 | Review

Subintimal Angioplasty for Peripheral Arterial Occlusive Disease: A Systematic Review

Authors: Rosemarie Met, Krijn P. Van Lienden, Mark J. W. Koelemay, Shandra Bipat, Dink A. Legemate, Jim A. Reekers

Published in: CardioVascular and Interventional Radiology | Issue 4/2008

Abstract

The objective of this study was to summarize outcomes of subintimal angioplasty (SA) for peripheral arterial occlusive disease. The Cochrane Library, Medline and Embase databases were searched to perform a systematic review of the literature from 1966 through May 2007 on outcomes of SA for peripheral arterial occlusive disease of the infrainguinal vessels. The keywords “percutaneous intentional extraluminal revascularization,” “subintimal angioplasty,” “peripheral arterial disease,” “femoral artery,” “popliteal artery,” and “tibial artery” were used. Assessment of study quality was done using a form based on a checklist of the Dutch Cochrane Centre. The recorded outcomes were technical and clinical success, primary (assisted) patency, limb salvage, complications, and survival, in relation to the clinical grade of disease (intermittent claudication or critical limb ischemia [CLI] or mixed) and location of lesion (femoropopliteal, crural, or mixed). Twenty-three cohort studies including a total of 1549 patients (range, 27 to 148) were included in this review. Methodological and reporting quality were moderate, e.g., there was selection bias and reporting was not done according to the reporting standards. These and significant clinical heterogeneity obstructed a meta-analysis. Reports about length of the lesion and TASC classification were too various to summarize or were not mentioned at all. The technical success rates varied between 80% and 90%, with lower rates for crural lesions compared with femoral lesions. Complication rates ranged between 8% and 17% and most complications were minor. After 1 year, clinical success was between 50% and 70%, primary patency was around 50% and limb salvage varied from 80% to 90%. In conclusion, taking into account the methodological shortcomings of the included studies, SA can play an important role in the treatment of peripheral arterial disease, especially in the case of critical limb ischemia. Despite the moderate patency rates after one year, SA may serve as a “temporary bypass” to provide wound healing and limb salvage.

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Title: Subintimal Angioplasty for Peripheral Arterial Occlusive Disease: A Systematic Review
Authors: Rosemarie Met
Krijn P. Van Lienden
Mark J. W. Koelemay
Shandra Bipat
Dink A. Legemate
Jim A. Reekers
Publication date: 01-07-2008
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 4/2008
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-008-9331-7

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Subintimal Angioplasty for Peripheral Arterial Occlusive Disease: A Systematic Review

Abstract

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