Subintimal Recanalization Is Safe and Effective in Treating Chronic Critical Limb Ischemia in Selected Patients

Harthun, Nancy L.; Cage, Dorothy L.; Spinosa, David J.
June 2004
American Surgeon;Jun2004, Vol. 70 Issue 6, p479
Academic Journal
Subintimal recanalization is a percutaneous technique that allows revascularization in patients with limb-threatening ischemia. It was first described by Bolia (Cardiovasc Intervent Radiol 13;357-63:1990) but has not gained widespread use in the United States. Twenty-five patients with 32 threatened limbs were referred from a single surgeon's practice over a 23-month period. All patients were either high-risk surgical patients, due to severe medical comorbidities, or not surgical candidates due to poor target vessels, lack of appropriate conduit, or failed previous surgical revascularizations. The average age of patients was 69. There were 15 men and 10 women treated. Subintimal recanalization was immediately successful in 30 limbs. One peri-procedural death occurred, although this patient underwent a surgical bypass graft procedure in the same hospitalization. Three significant complications occurred (myocardial infarction, ventricular arrhythmia, and gastrointestinal hemorrhage). Primary patency is 83 per cent. Secondary patency is 90 per cent. Limb salvage rate is 88 per cent. Mean follow-up period is 10 months. Eight patients died in the follow-up period due to unrelated causes.


Related Articles

  • Arterial Occlusion After Repetitive Angio-Seal Device Closure. Van Den Broek, Theo; Liqui Lung, Paul F.; Suttorp, Maarten-Jan; Eefting, Frank D.; Schipper, Marguerite E. I.; Vink, Aryan // Vascular & Endovascular Surgery;Aug/Sep2007, Vol. 41 Issue 4, p346 

    The article presents three cases in which the radial artery was used as a bypass graft for emergent limb salvage operations in patients who had multiple prior lower extremity bypass operations that had exhausted their own supply of autogenous vein. The results indicates that the vein grafts...

  • Large Gastric Perforation In A Neonate. Parmar, Girish; Khoradiya, Mahesh; Ambasana, B. C. // Internet Journal of Surgery;2010, Vol. 24 Issue 2, p1 

    Large gastric perforation in a neonate is very rare condition. We are reporting such a condition in a two-day-old male child. This condition requires urgent surgical intervention. We did emergency laparotomy with suturing of large gastric perforation in two layers.

  • Long-Term Outcomes of Acute Ischemic Stroke in Patients Aged 80 Years and Older. Yang-Ki Minn; Soo-Jin Cho; Seon-Gyeong Kim; Ki-Han Kwon; Jin-Hyuck Kim; Mi-Sun Oh; Min-Kyung Chu; Ju-Hun Lee; Sung Hee Hwang; Byung-Chul Lee // Yonsei Medical Journal;6/30/2008, Vol. 49 Issue 3, p400 

    Purpose: Short life expectancy influences decision-making when treating very old patients with acute ischemic stroke (AIS). We investigated mortality and survival duration in very old AIS patients (≥ 80 years) who received hospital care. Patients and Methods: Mortality data were obtained...

  • Proportion of Patients with Critical Limb Ischemia Who Require an Open Surgical Procedure in a Center Favoring Endovascular Treatment. GARGIULO III, NICHOLAS J.; O'CONNOR, DAVID J. // American Surgeon;Mar2011, Vol. 77 Issue 3, p315 

    Endovascular interventions have gained widespread acceptance as primary and secondary treatments for critical lower extremity ischemia (CLI), and many believe there is little need for open bypasses for CLI. Despite this, some patients presenting with CLI require traditional lower extremity...

  • The evaluation of primary stenting of sirolimus-eluting versus bare-metal stents in the treatment of atherosclerotic lesions of crural arteries. Falkowski, Aleksander; Poncyljusz, Wojciech; Wilk, Grażyna; Szczerbo-Trojanowska, Małgorzata // European Radiology;Apr2009, Vol. 19 Issue 4, p966 

    A comparison was made of sirolimus–eluting stents and bare stents as an effective means of treatment of stenosis in crural arteries. Patients were randomly divided into two groups: (1) patients treated with sirolimus-eluting stents and (2) patients treated with bare stents. Each group...

  • Preoperative Topical Hypothermia used in Prolonged Severe Lower Limb Ischemia to Avoid Ischemic Damage - The First Clinical Experience. Forsell, Claes; Åberg, Jonas; Szabó, Zoltán // International Journal of Biomedical Science;Sep2013, Vol. 9 Issue 3, p181 

    Severe lower limb ischemia TASC IIB/III with sensory and motor neurologic deficiencies leads to prolonged hospital care, amputation, and death in 20-70 % of cases. We present our first clinical experience of the use of preoperative topical hypothermia to improve muscular viability in these...

  • Outcomes of Intra-arterial Thrombolysis for Acute Limb Ischemia. Amonkar, S. J.; Cleanthis, M.; Nice, Colin; Timmons, Grace; Mudawi, A. M.; Ashour, H. Y.; Bhattacharya, V. // Angiology;Dec2007/Jan2008, Vol. 58 Issue 6, p734 

    lntra-arterial thrombolysis is an alternative treatment to surgery for acute limb ischemia. We report our own experiences by retrospectively assessing initial and long-term outcomes using this strategy. Patients (n = 48; 50 events) underwent thrombolysis according to our protocol (64.6% male,...

  • Procedural and Clinical Outcomes With Catheter-Based Plaque Excision in Critical Limb Ischemia. Kandzari, David E.; Kiesz, R. Stefan; Allie, David; Walker, Craig; Fail, Peter; Ramaiah, Venkatesh G.; Cardenas, Joseph; Vale, Jose; Chopra, Atul; Gammon, Roger S. // Journal of Endovascular Therapy;Feb2006, Vol. 13 Issue 1, p12 

    Purpose: To examine the safety and efficacy of catheter-based plaque excision as an alternative therapy to surgery, conventional angioplasty, and/or stenting in high-risk patients with critical limb ischemia (CLI). Methods: Between August 2003 and August 2004, a prospective evaluation was...

  • Foot Embolization During Limb Salvage Procedures in Critical Limb Ischemia Patients Successfully Managed With Mechanical Thromboaspiration. Gandini, Roberto; Merolla, Stefano; Chegai, Fabrizio; Del Giudice, Costantino; Stefanini, Matteo; Pampana, Enrico // Journal of Endovascular Therapy (Sage Publications Inc.);Aug2015, Vol. 22 Issue 4, p558 

    Purpose: To illustrate the use of a mechanical thromboaspiration device originally designed for clot retrieval in acute stroke in the treatment of acute distal embolism occurring during percutaneous revascularization of the femoropopliteal and below-the-knee arterial segments. Technique: The...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics