Background: There are limited data comparing the outcomes of subintimal vs. intraluminal approach in the treatment of long femoropopliteal artery occlusions. The objective of this study was to investigate the efficacy and safety of the subintimal approach for long femoropopliteal artery occlusions. Methods and Results: From a multicenter retrospective registry cohort, we included a total of 461 patients with 487 femoropopliteal artery occlusions classified as Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) II C/D for this analysis. We compared the immediate and mid-term outcomes of subintimal vs. intraluminal approaches. There were 228 patients with 243 limbs in the subintimal group, and 233 patients with 244 limbs in the intraluminal group. Baseline clinical and lesion characteristics were comparable between the 2 groups. The technical success rate was significantly higher in the subintimal group than in the intraluminal group (95.1% vs. 89.8%, P=0.041). The clinical primary patency (67.5% vs. 73.4% at 12 months, 54.0% vs. 61.3% at 24 months; P=0.086) and target lesion revascularization (TLR)-free survival (89.5% vs. 86.3% at 12 months, 77.6% vs. 76.0% at 24 months; P=0.710) did not differ significantly between the subintimal and the intraluminal groups. Conclusions: In long femoropopliteal occlusions, the subintimal approach achieved a higher technical success rate and similar mid-term primary patency and TLR-free survival compared with intraluminal approach.
Bibliographical noteFunding Information:
This study was supported by grants from the Korean Vascular Intervention Society; the Mid-Career Researcher Program through an NRF grant funded by the MEST, Republic of Korea (2015R1A2A2A01002731); and the Cardiovascular Research Center, Seoul, Korea.
© 2018, Japanese Circulation Society. All rights reserved.
- Chronic total occlusion
- Femoropopliteal artery
- Peripheral artery disease
- Subintimal angioplasty
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine