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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
LOWER EXTREMITIES HOT TOPICS
Italian Journal of Vascular and Endovascular Surgery 2012 June;19(2):73-6
Optimal endovascular approach for TASC C and D lesions: intraluminal or subintimal angioplasty?
Mameli A., Boufi M., Alimi Y. S.
Department of Vascular Surgery, North Marseille University Hospital, Marseille, France
Endovascular approach for long lesions involving superficial femoral artery has gained an increasing part in the treatment of lower limb arterial occlusive disease. TASC C and D lesions are the most problematic to treat, because of their length and very often calcified wall. Originally described to improve patency rate in endovascular lower limb interventions, subintimal angioplasty (SIA) appears more and more debated in its durability and as an effective alternative to bypass surgery. Transluminal (or intraluminal) angioplasty PTA, historically first method of endovascular treatment, comes back on the endovascular scene, as a serious challenger to SIA in long lesions, since an improved patency with adjunct of stents have been established, and due to its less rate of arterial run off threatening in case of failure. Improvement in devices with dedicated catheters and innovations involving balloons and stents has changed possibilities on both sides. This review has the goal to establish the exact place of SIA and PTA for challenging long lesions, with an arborescence for decision making in common practice.