The role of subintimal angioplasty in the management of arterial disease of the lower limb: The north-east of Scotland experience

Introduction: The management of occlusive femoropopliteal disease continues to evolve and a definitive strategy remains to be defined. We examine the utility of subintimal angioplasty (SIA) in our institution. Methods: A retrospective study with predefined end-points, including technical success and primary patency. Results: 61 consecutive cases were identified (claudicants n=29 and critical ischaemia n=32). Sixty-four percent of occlusions were greater than 10cm with poor run-off (60% with two vessels or less). Technical and physiological success was 95% and 79% respectively, with clinical improvement reported by 72%. At a mean follow-up of 20 months twelve-month primary patency (assessed clinically, with ABPI and selective duplex scanning) was 67% (subgroup analysis: claudicants 83%, criticals 53%, p=0.02) and morbidity 8% with no limb loss or procedure related mortality. Conclusion: SIA is an effective procedure for chronic lower limb ischaemia with acceptable outcome. Our experience correlates well with evidence in the current literature.