Iliac Subintimal Angioplasty: A Viable Alternative to Open Revascularization

Objective: Subintimal angioplasty (SIA) is an increasingly utilized endovascular technique, yet there is little reported experience with this technique for treatment of iliac artery occlusions. We examined our experience to determine the safety and feasibility of SIA for the treatment of these lesions.
Methods: From April, 2003 through July, 2006, 44 patients underwent SIA of 46 iliac artery occlusions. Technical success was defined as creation of a subintimal channel bypassing the level of occlusion with residual angiographic stenosis < 30%. Follow-up examinations included assessment of ankle-brachial indices and ultrasound studies at recommended intervals.
Results: SIA was performed for disabling claudication in 30 patients (68%) and for critical limb ischemia in 14 patients (32%). Technical success was achieved in 40 procedures (87%) and there were 4 minor complications (9%), none of which required repeat intervention. Stents were placed in 36 iliac arteries (78%). Mean follow-up was 10 months (range, 0-37 months), during which time there were no major amputations and 1 death. In patients undergoing successful SIA, primary patency was 85% and 72% at 6 and 12 months respectively. Four additional percutaneous procedures in 3 patients were required to maintain overall patency of 89% and 82% at 6 and 12 months.
Conclusion: Revascularization of the lower extremities in patients with iliac artery occlusions is safely and effectively achieved through SIA. At one year, primary patency is >70% and overall patency remains >80%. SIA is a viable treatment alternative to surgical bypass and a particularly appealing option for patients at high risk.