Subintimal angioplasty and stenting in chronic total femoropopliteal artery occlusions: Early- and mid-term outcomes

Tatlı, Ersan; Buturak, Ali; Kayapınar, Osman; Doğan, Emir; Alkan, Mustafa; Gündüz, Yasemin

doi:10.5603/cj.a2014.0043

Cited by 10 publications

(5 citation statements)

References 28 publications

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“…For antegrade access, the guidewire is passed through the occluded SFA stent. Then, predilation with a balloon and stenting of the neolumen is performed [34,35]. It has been reported that the procedural success of revascularization of an occluded SFA stent in cases performed with the antegrade approach is only 13% to 26% [36].…”

Section: Discussionmentioning

confidence: 99%

Antegrade and retrograde access in the endovascular treatment of femoropopliteal chronic total occlusions

Donbaloğlu¹,

Gürkan²,

Gür³

2023

Turk J Vasc Surg

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Aim: In this study, the aim was to investigate whether antegrade or retrograde approaches are superior in the endovascular treatment of femoropopliteal chronic total occlusions (CTO). Material and Methods: A total of 437 patients who were diagnosed with CTO in the femoropopliteal region and who subsequently underwent endovascular procedures between February 2019 and April 2022 were evaluated retrospectively. The patients were grouped as antegrade access and retrograde access. All patients were classified according to the Rutherford and TASC (Transatlantic Intersociety Consensus II) classification. The patients were followed for 2 years. Above-ankle amputation and >50% stenosis in the target vessel were considered a failure. ABI, improvement in clinical symptoms, and limb salvage were evaluated in controls. Results: Antegrade approach was performed in 218 of the endovascular procedures. Antegrade recanalization was successful in 201 patients (92.2%), and failed antegrade attempt was seen in 17 because the lesion could not be crossed. Retrograde approach was used in 197 of endovascular interventions. Successful retrograde recanalization was unsuccessful in 185 patients (93.9%), and retrograde intervention was unsuccessful in 12 patients because the lesion could not be crossed. When the two-year restenosis numbers were examined, it was 61 (30.3%) in the antegrade group, while it was 49 (25.5%) in the retrograde group, and there was a significant difference between the groups. When the one-year stent occlusions between the groups were examined, it was 14 (6.9%) in the antegrade group and 8 (4.1%) in the retrograde group, and there was a statistically significant difference between the groups. Conclusion: The retrograde approach is as effective and safe as the antegrade approach in the treatment of femoropopliteal CTO. It should be noted that it can be used as an alternative method without the need for any support device, especially in cases where the antegrade approach is unsuccessful.

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Section: Discussionmentioning

confidence: 99%

Antegrade and retrograde access in the endovascular treatment of femoropopliteal chronic total occlusions

Donbaloğlu¹,

Gürkan²,

Gür³

2023

Turk J Vasc Surg

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“…Failure of successful CTO intervention may be due to failure to cross the CTO proximal cap or the inability to reenter the true lumen after subintimal tracking. Subintimal angioplasty and stenting is a safe and effective therapy for chronic total occlusion revascularization with favorable patency at mid-term and a longterm patency that is comparable with secondary patency of autologous vein bypass [117][118][119]. In patients with CLI, retrograde pedal access after a failed antegrade recanalization attempt appears to be a safe, feasible and promising technique for limb salvage in high-risk patients who are not surgical candidates [120,121].…”

Section: Chronic Total Occlusionsmentioning

confidence: 96%

Endovascular therapy for critical limb ischemia

Domínguez

Bahadorani

Reeves

et al. 2015

Expert Review of Cardiovascular Therapy

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Critical limb ischemia (CLI) represents an advanced disease state of peripheral arterial disease. It manifests as lower extremity ischemic rest pain or ischemic skin lesions leading to ulceration or gangrene. Patients with CLI often have multiple medical comorbidities and a 1-year mortality rate of 25% and a 1-year amputation rate of 25%. Historically, bypass surgery with autogenous veins for flow restoration has been the first-line therapy for CLI. However, advances in endovascular techniques and device technology have changed the treatment paradigm. Catheter-based technologies are rapidly evolving at a rate that is outpacing large-scale studies evaluating relevant clinical outcomes. Patients with CLI require a multidisciplinary management approach centered on aggressive medical therapies, wound care and prompt revascularization, with an emphasis on limb salvage. This review summarizes the contemporary endovascular therapies including balloon angioplasty, atherectomy and bare-metal stenting. In addition, we review emerging technologies, such as drug-eluting stents, drug-coated balloons and chronic total occlusion recanalization devices.

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“…However, as operators accumulated experience and adopted retrograde approaches from distal arteries and using re-entry devices, the technical success rate gradually improved ( Tables 1 and 2 ). 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) 22) 23) 24) …”

Section: Technical Successmentioning

confidence: 99%

SFA Intervention: Intraluminal or Subintimal?

2018

Korean Circ J

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Subintimal angioplasty (SA) is an endovascular technique to recanalize an occluded arterial segment through an extraluminal channel between the intima and media. Since its introduction in 1989, the technical success rate has improved with the accumulation of procedural experience and the development of retrograde approaches and re-entry devices. To date, no randomized trial has compared SA with intraluminal angioplasty (IA) for chronic total occlusion (CTO) of the superficial femoral artery (SFA). Based on limited data from several registry studies, SA appears to achieve a higher technical success rate than IA, whereas mid-term primary patency rates are comparable for both endovascular wiring strategies for SFA CTO. Additional clinical data are needed to confirm that SA is as effective as IA. The optimal stenting strategy and role of drug-eluting technologies also need to be defined to improve SA outcomes.

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Subintimal angioplasty and stenting in chronic total femoropopliteal artery occlusions: Early- and mid-term outcomes

Abstract: (Cardiol J 2015; 22, 1: 115-120)

Cited by 10 publications

References 28 publications

Antegrade and retrograde access in the endovascular treatment of femoropopliteal chronic total occlusions

Antegrade and retrograde access in the endovascular treatment of femoropopliteal chronic total occlusions

Endovascular therapy for critical limb ischemia

SFA Intervention: Intraluminal or Subintimal?

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