Subintimal Angioplasty Proven To Be Effective Critical Limb Ischemia Treatment - Appears To Produce Consistently High Limb Salvage Rates

Main Category: Cardiovascular / Cardiology
Also Included In: Medical Devices / Diagnostics;  Vascular
Article Date: 24 Nov 2008 - 5:00 PDT

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Critical limb ischemia is becoming an increasingly common condition in our aging population. The greatest advantage of endovascular management of critical limb ischemia is that all the significant lesions in the aortoiliac, femoropopliteal or the tibial segments can be managed at one sitting, thus providing the best possibility of producing a good straight line flow down to the foot.

Any technique that allows long occlusions to be recanalized will have the biggest impact on the treatment of critical limb ischemia. To get past the lesion the device must go into the wall of the vessel and come out past the lesion, and then the balloon is activated, going in the vessel wall.

Amman Bolia, M.D., Senior Lecturer at the University of Leicester and Consultant Vascular Radiologist at the Leicester Royal Infirmary in the United Kingdom, views subintimal angioplasty (entering the wall of the blood vessel to travel down to the lesion) of tibial occlusive disease as an established first line treatment for patients with critical limb ischemia.

He says it offers a safe, effective, inexpensive and a low risk alternative to distal reconstructive surgery and most importantly, high limb salvage rates are achievable.

The technique involves entering the subintimal space using catheters and hydrophilic guidewires. Full-length occlusions of 30cm or over can be crossed using this method. Subintimal angioplasty has made a major impact on the treatment of critical limb ischemia and the majority of the publications have shown limb salvage rates of around 90% at 12 and 24 months.

Various devices including atherectomy, lasers and cryoplasty have been attempted in the infrainguinal segment but they all appear to have limitations of primary success, complications, and cost implications.

Dr. Bolia acknowledged that bypass surgery has been viewed as the gold standard for the treatment of peripheral vascular disease and has produced durable results when a vein graft has been used.

But, good anastomoses are difficult with severely diseased tibial vessels and surgery is not without morbidity or mortality.

Dr. Bolia believes that subintimal angioplasty has proven to be an effective treatment for the treatment of critical limb ischemia and appears to produce consistently high limb salvage rates. However, he did remind the audience that "There is a learning curve - therefore the sooner you begin, the sooner you can begin to help your patients."

VEITH SYMPOSIUM - New York, November 19th to 23rd

Now in its fourth decade, VEITH SYMPOSIUM provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features rapid-fire presentations from world renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.

VEITHsymposium is sponsored by Cleveland Clinic, Cleveland, OH.

www.veithsymposium.org

Source
Pauline T. Mayer
www.ptmhcm.com

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