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Abstract
Infrapopliteal SIA in the treatment of patients with occluded crural arteries and critical lower limb ischaemia is feasible in a large number of patients. If correctly performed, it is a safe technique which provides high success rates in limb salvage.
Our data require validation on a larger series with middle- and long-term follow-up.
Nonetheless, the preliminary results obtained in the Percutaneous revascularization of occluded infrapopliteal vessels demonstrate the feasibility of SIA as a first-line treatment in patients with CLI as well as its numerous advantages as opposed to surgery.
Bypass surgery is still considered the gold standard and 1st line treatment for critical lower limb ischemia due popliteo-tibial arterial segment occlusive diseases, due to more durability and more patency rates and limb salvage rates in comparison to subintimal angioplasty.
SIA is a useful technique especially in patients with co-morbidity and high risky in withstanding major long bypass operations with anesthetic risks or patients with unavailable conduit.
Subintimal angioplasty has an accepted patency and limb salvage rates, and when applied judiciously, without disturbing the major collateral vessel supplying the limb beyond the occlusion, bypass options are preserved.
There are many advantages of this technique, including reduced anesthesia requirements, a minimally invasive approach, and potential reductions in length of stay and cost subintimal angioplasty will continue to have a role in the treatment of lower extremity ischemia.
Finally, when a subintimal angioplasty fails, it frequently does so without the recurrence of symptoms, especially when a gangrenous lesion or ulcer has healed.
Frequent clinical follow-up and a duplex surveillance program are necessary to assess patency of subintimal angioplasty; early detection of recurrence of symptoms and a decrease in ABI are good indicators for late failure of the procedures for further duplex or conventional angiographic assessment and 2ry intervention if needed to improve the patency rates and limb salvage.
Our follow-up to date is somewhat limited, and the ultimate utility and applicability of this technique will be determined by its long-term results.