A study presented at the SIR annual meeting looking at treatment of superficial femoral arteries and tibial arteries in patients with chronic critical limb ischemia with subintimal angioplasty, followed by stenting as needed, was highly successful in restoring blood flow non-surgically and preventing amputation.
Lead author Dr David Spinosa, said the findings were significant because patients with severe critical limb ischemia typically have poor wound healing and increased risk of infection following bypass surgery in the leg.
The study involved 79 patients with chronic critical limb ischemia; 77% had tissue loss and 23% had rest pain alone. The blood flow to the patients' feet was so restricted from peripheral arterial disease (PAD) that most were not candidates for arterial bypass surgery, and were facing amputation of their foot and leg. Re-establishing straight line blood flow to the foot was accomplished in 100% of the patients.
The patients were divided into two groups, both of which had the superficial femoral artery/popliteal segments treated. Group one, who had lesions <200 mm long, received subintimal angioplasty with stenting as needed. Group two had lesions >200 mm, and all received subintimal angioplasty and stenting, to determine if routine stenting was beneficial. The six-month limb salvage rates in group one were 86% and 90% for group two. Stenting the longer segments >200mm did not appear to improve the limb salvage compared to stenting as needed after subintimal angioplasty.
During the procedure, a catheter is threaded through the femoral artery in the groin, to the blocked artery in the legs. It is then passed through the layers in the blocked artery wall (the subintimal space) and then back into the lumen (the interior channel of the blood vessel through which blood flows) of the artery. A balloon is then inflated to open a channel in the wall of the blood vessel where it is narrowed or blocked. In some cases, this is then held open with a stent. Subintimal angioplasty differs from the usual intraluminal angioplasty because it is performed in the wall of the artery rather than in the lumen of the artery, like traditional angioplasty.
Spinosa concluded that offering a potentially successful treatment for these long lesions in patients who typically have few options other than amputation is important and shows that treatments for very severe peripheral arterial disease in the smallest vessels, even those with long lesions, in both patients who are candidates for bypass surgery and in those who may not be, is possible.
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