Subintimal versus intraluminal laser-assisted recanalization of occluded femoropopliteal arteries: one-year clinical and angiographic follow-up

Abstract

Purpose: To compare the prolonged effect of subintimal versus intraluminal recanalization of occluded femoropopliteal arteries.

Patients and methods: Recanalization of an occluded femoropopliteal artery was attempted in 63 patients (51 men, 12 women; mean age, 63 years) with lifestyle-limiting claudication and at least one patent distal artery. After assessment of baseline clinical and angiographic variables, mechanical passage was first attempted with use of a laser catheter with a 2.2-mm- diameter hemispherical contact probe that was connected to a neodymium: yttrium-aluminum-garnet laser. In case of failure, the laser was activated at 1-second pulses of 15 W. In some cases additional guide-wire and catheter manipulations were used. Successful recanalization was followed by standard balloon dilation. An intense antithrombotic regimen was used.

Results: The occluded artery could be entered in 62 of 63 patients. The catheter was assumed to have followed a subintimal course in 20 patients (group A) and an intraluminal course in 42 patients (group B). Successful recanalization was achieved in 17 patients (85%) of group A and in 36 (86%) of group B. No significant differences were found in clinical and angiographic follow-up measurements between the two groups. The angiographic cumulative primary patency rate (open vs closed) at 1 year was 93% +/- 6 in group A and 93% +/- 4 in group B. The cumulative restenosis/reocclusion-free patency rate was 63% +/- 13 and 65% +/- 9 for groups A and B, respectively. Median length of the original occlusion (8.0 cm in group A vs 4.5 cm in group B) was the only distinguishing baseline variable between the groups (P < .02) and was also the single independent predictor of recurrent flow limitation (P = .0017). Significant complications were distal embolization in three patients, followed by death in one patient and puncture site bleeding in two patients.

Conclusion: The 1-year clinical and angiographic results of assumed subintimal and intraluminal recanalization are comparable. Thus, a subintimal course per se should not be regarded as a failure of the procedure.