Combined subintimal and intraluminal angioplasty in the treatment of critical limb ischemia

The objective of this study was to develop a new approach in the endovascular treatment of critical limb ischemia based on the combined use of subintimal and intraluminal angioplasty methods. Patients with critical limb ischemia were considered suitable candidates for angioplasty if they did not show irreversible changes of the limb that would require amputation at the shin or thigh level. Between 2004 and 2008, 139 endovascular interventions were carried out in 126 patients. The procedure was technically successful in 90.5% of cases. Such a high frequency of success was achieved due to the use of standards for endovascular treatment. The frequency of major complications did not exceed 7%. The probability of absence of critical limb ischemia recurrence within one year amounted to 65%. A significant part of the patients were regarded as «unsuitable» for surgical treatment due to severe concomitant pathology, "unsatisfactory" state of the distal circulation or the presence of infection on the foot. This, together with the low life expectancy of the patients, shows the obvious advantages of combined subintimal and intraluminal angioplasty over surgical revascularization as a method of critical limb ischemia treatment.

Critical limb ischemia, diabetes mellitus, diabetic foot, transluminal balloon angioplasty, subintimal angioplasty, intraluminal angioplasty, stenting