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    Subintimal angioplasty: predictors of long-term success.

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    Authors
    Keeling, Aoife N
    Khalidi, Karim
    Leong, Sum
    Given, Mark F
    McGrath, Frank P
    Athanasiou, Thanos
    Lee, Michael J
    Affiliation
    Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
    Issue Date
    2009-08
    MeSH
    Aged
    Aged, 80 and over
    Angioplasty
    Female
    Humans
    Intermittent Claudication
    Ischemia
    Leg
    Longitudinal Studies
    Male
    Middle Aged
    Peripheral Vascular Diseases
    Treatment Outcome
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    Citation
    Subintimal angioplasty: predictors of long-term success. 2009, 20 (8):1013-22 J Vasc Interv Radiol
    Journal
    Journal of vascular and interventional radiology : JVIR
    URI
    http://hdl.handle.net/10147/127492
    DOI
    10.1016/j.jvir.2009.05.005
    PubMed ID
    19647180
    Abstract
    To determine the clinical outcomes and success rates after percutaneous subintimal angioplasty (SIA) in patients with lower-limb occlusive lesions causing intermittent claudication (IC) or critical limb ischemia (CLI) at midterm to long-term follow-up. The secondary aim was to elicit factors predictive of a successful outcome.
    Between January 1999 and June 2006, 75 consecutive patients (45 men; age range, 46-91 years; CLI in 79%) underwent SIA of iliac and infrainguinal (84%) occlusions. Outcomes were determined on an intent-to-treat basis. The composite endpoint of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up, which was defined as the development of IC, CLI, or need for subsequent endovascular or surgical revascularization. Actuarial freedom from MACO was assessed via Kaplan-Meier curves and multivariable Cox proportional-hazards regression.
    SIA was performed on 75 lesions, with an initial procedure success rate of 83% (n = 62). Procedure failure was caused by heavily calcified lesions (n = 5) and failure of reentry (n = 8). A total of 56.3% of patients with claudication were free from ipsilateral claudication at follow-up (mean, 32 months; range, 1-64 months), and those with CLI had a 79.7% limb salvage rate at a mean follow-up of 30.7 months (range, 0.5-91 months). On Cox regression analysis, the following variables were identified as independent predictors of MACO within the limb treated with SIA: ABI after SIA (hazard ratio, 0.21; 95% CI, 0.05-0.89; P = .035) and number of patent runoff vessels (ie, /=2; hazard ratio, 0.29; 95% CI, 0.15-0.59; P = .001).
    SIA is a feasible therapeutic option for occlusive atherosclerotic lesions in IC and CLI and is the evolving preferred strategy in CLI and perhaps IC with long-segment occlusions.
    Item Type
    Article
    Language
    en
    ISSN
    1535-7732
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jvir.2009.05.005
    Scopus Count
    Collections
    Beaumont Hospital

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