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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2008 September;15(3):187-99
Role of subintimal angioplasty (SAP) for critical limb ischemia
Vascular Centre Malmö-Lund, University Hospital MAS Malmö, Sweden
Ever since Dr. Bolia et al. published their paper of intentional subintimal angioplasty more than 20 years ago it have become a more and more used technique in several centres around the world. Its popularities have gained the last 5 years, following a number of publications from various centres in Europe and the USA. After its initial successes in the femoropopliteal segment, the techniques has been extended to the infrapopliteal segment recanalization of long tibial occlusions and the possibility of reconstituting the trifurcation have proved to be most useful in the treatment of patients with critical limb ischemia. Primary success rates of more than 85% can be expected in the infrainguinal and the infrapopliteal segment. Primary patency of 40% at >3 years in the infrainguinal arteries for critical limb ischemia has been reported. Limb salvage rates have been consistently high at around 85 to 90% at 1 year. Development of new dedicated devices and the use of stents in the subintimal recanalization have facilitated the technique and improved the technical and clinical outcome. Subintimal angioplasty has proved to be a useful and inexpensive way to treat critical limb ischemia.