A Prospective Evaluation of Percutaneous Subintimal Angioplasty and Routine Stenting for TASC C and D Lesions of the Superficial Femoral Artery

Purpose: To assess clinical success and patency of superficial femoral artery (SFA) subintimal percutaneous angioplasty (PTA) and routine stenting for TASC C and D lesions.
Methods: From 2003-2006, patients with infra-inguinal TASC-C & D lesions and chronic limb ischemia underwent subintimal PTA and routine stenting as the primary treatment. Patients were followed-up at 1, 3, and every 6 month intervals with PVR and clinical assessment. Patients with recurrent symptoms or abnormal PVRs were re-evaluated and treated accordingly. Data was prospectively collected and an intention to treat analysis was performed.
Results: Since 2003, 241 patients underwent attempted subintimal PTA and stenting for TASC-C & D lesions for disabling claudication (68%), rest pain (18%), and tissue loss (14%), and initial success was obtained in 236 (98%) patients. The mean lesion length was 21 cm (±9.8cm) and the mean tibial runoff score was 2.2. During the mean follow-up of 16 months (range: 3-42 months), all patients experienced improvement and there was a significant rise in the mean ABI from 0.62 to 0.96. Eight (3.4%) patients developed recurrent stenosis; 5 (2.1%) underwent femoral-popliteal bypass, 2 (0.8%) had repeat PTA for restenosis, and 1 (0.4%) was untreated. One (0.4%) patient re-occluded within 30 days and underwent a femoral- popliteal bypass, and there were no limb losses.
Conclusions: Percutaneous subintimal PTA and stenting for TASC C and D SFA lesions is technically safe and effective for treatment of chronic limb ischemia and might have higher patency rates than usually reported for transluminal PTA and selective stenting.