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Patients at risk for open surgery or leg amputation due to chronic total occlusions in peripheral artery disease (PAD) may elect to have non-invasive subintimal angioplasty (SIA), a technically feasible procedure for revascularization. A study which revealed the success of more than 600 patients treated with SIA was presented today at the 61st Annual Meeting of the Society for Vascular Surgery.

“Subintimal angioplasty was technically successful in 85 percent of our patients,” said Eric C. Scott, MD, a vascular surgery fellow from Eastern Virginia Medical School and Vascular and Transplant Specialists in Norfolk, Va. “With routine clinical follow-up (mean 12.5 months) and occasional repeat procedures to re-open narrowed or blocked portions of the channel, 50 percent of the subintimal channels remained open at three years. Seventy-two percent of patients had their legs saved by this technique. While subintimal angioplasty does not preclude patients from undergoing future open bypass surgery, we found only one-third of our patients required it during the three years after the procedure.” 

He added that the procedure’s minimally-invasive nature and efficacy make it an appealing option for older patients, those with multiple medical conditions, or for patients too ill for bypass surgery.

During the procedure, a small wire is used to create a new channel within the blocked artery. This channel is then enlarged with an angioplasty balloon, restoring blood flow to the leg. Unlike open bypass surgery, which requires multiple incisions and a hospital stay of four to seven days, subintimal angioplasty is performed through a needle puncture in the groin and allows patients to return home within 24 hours. The femoropopliteal segment was treated in 71 percent of procedures; treatment in the remainder was performed for iliac, tibial artery or multiple occlusions.

“The treatment of patients with disabling claudication or critical limb ischemia secondary to chronic total occlusions has changed dramatically with the incorporation of SIA into the practice of vascular surgery,” said Dr. Scott. “Vascular surgeons have traditionally relied on open surgery to treat patients who had arterial blockages in the legs accompanied by pain, ulceration, tissue death or who were at risk for amputation. Treatment included using portions of patient’s own vein or plastic grafts to perform bypass surgery in the leg, providing new routes of blood flow to the lower leg and foot. New minimally-invasive bypass procedures offer similar results without open surgery.”

He added that primary patency was lower than that of autologous vein bypass, but following additional percutaneous procedures, secondary patency was comparable to traditional surgical outcomes. “Our research shows that subintimal angioplasty is an appropriate initial therapy for many patients with PAD,” added Dr. Scott.