Subintimal Angioplasty for Infrainguinal Occlusions: Does Length of Occlusion Matter?

Objectives: Subintimal angioplasty (SIA) of the femoropopliteal arteries is an endovascular alternative to open bypass surgery for patients with arterial occlusion. This review of our experience with SIA was undertaken to evaluate the effect of occlusion length on technical success and patency.
Methods: A review of patients undergoing SIA for treatment of femoropopliteal occlusions at a multi-center vascular practice was performed. Demographic data, technical success, length of treated segment, and patency were recorded. Patients were then grouped by length of treated segment and compared for differences in technical success and patency.
Results: Between September, 2002 and December, 2005, 138 patients underwent SIA of the superficial femoral or popliteal arteries. The procedure was technically successful in 118 patients (86%). The length of subintimal channel did not influence technical success. Of the patients successfully treated, 69 (58%) remained patent at a mean follow-up of 6 months, while 49 (42%) had been revised or failed. While there was a trend toward improved 6-month patency in patients with occlusions of 20 cm or less, this was not statistically significant.
Conclusions: The outcome of SIA does not appear to be related to the length of occlusion. Neither technical success nor short term patency was related to length of occlusion in a statistically significant fashion. In light of this data, as well as accumulating data on the short and mid-term durability of the procedure, SIA is a viable endovascular option for the treatment of arterial occlusion, independent of the length of occlusion.