SUBINTIMAL RECANALIZATION AND STENTING FOR LONG SUPERFICIALFEMORAL ARTERY OCCLUSIONS

Risultato della ricerca: Other

Abstract

Objective: To assess the feasibility and mid-term outcome of combinedsubintimal recanalization and stenting for the treatment of long superficialFebruary, and then Protégé® EverFlexTM) were placed in the whole subintimalspace. The number and the length of stents was dictated from the length ofthe intentional subintimal dissection. The site of re-entry was chosen withoutcompromise the feasibilty of a future bypass grafting. When completion arteriogramrevealed residual stenosis, a post-dilatation was performed.Results: Twenty-eight patients (90.3%) underwent successful procedures,whereas two attempts failed because of inability to pass the guidewire throughSFA occlusion and one because of arterial perforation. Two of the patients withunsuccessful SFA subintimal recanalization underwent successful leg bypass andone required an above-knee amputation. Arterial stenoses proximal or distal tothe recanalized segment were treated with concomitant balloon angioplastiesin five (16.2%) cases. The mean ABI increased to 0.87 (range 0.62-1.0) after theprocedures. All the patients with successful SFA subintimal recanalization andstenting had resolution of symptoms and healing of ischemic lesions.Twenty-three of the 28 patients (82.1%) who had successful SFA procedureswere patent at a mean follow-up of 21±6 months (range 2-57 months), andoverall survival was 80.7%.Conclusions: Subintimal recanalization and routine stent placement allowshigh technical success rates and mid-term patency rates in the managementof long SFA occlusions, with no significant procedure-related complications.femoral artery (SFA) occlusions.Methods: From 2002 to 2006, 31 consecutive patients (22 male, 9 female)with severe chronic ischemia were intended to be submitted to subintimalwire placement and routine stenting of SFA. The mean age of the patientswas 67.3 years (range 61-79 years). Risk factors included diabetes mellitus(n=9, 29%) and end-stage renal failure (n=4, 12.9%). Thirteen patients (41.9%)were treated for disabling intermittent claudication, seven (22.6%) weretreated for rest pain and 11 (35.5%) for ischemic ulcers or gangrene. Themean ankle-brachial index (ABI) was 0.51 (range 0.28-0.72). The procedureswere performed under local anesthesia and using fluoroscopic guidancefor entering subintimal space with an angled 0.035’ hydrophilic guidewire(Radifocus; Terumo, Japan); in 14 (45.1%) cases of flush occlusion of SFA, theprocedures were made with associated duplex guidance to direct the devicesinto the SFA ostium. After advancement over the wire of a 5 Fr vertebralcatheter (Terumo, Japan) and re-entry into the true lumen at the distal endof the lesion, self-expandable nitinol stents (Bard® LuminexxTM until 2006,
Lingua originaleEnglish
PagineS28-S29
Numero di pagine2
Stato di pubblicazionePublished - 2007

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