Subintimal angioplasty in lower limb ischaemia.

Subintimal angioplasty has been around for 18 years but has become popular only in the last 2 to 3 years, following a number of publications from various centres in Europe and the USA. After its initial successes in the femoropopliteal segment, the techniques has been extended to the infrapopliteal segment. Recanalization of long tibial occlusions and the possibility of reconstituting the trifurcation has proved to be most useful in the treatment of patients with critical limb ischaemia. Primary success rates of between 80 and 90% can be expected in the infrainguinal and the infrapopliteal segment. Patencies of 64% at 5 years in the superficial femoral artery for claudication has been reported. Limb salvage rates have been consistently high at around 85 to 90% at 1 year. Subintimal angioplasty has proved to be a useful and inexpensive way to treat intermittent claudication. For critical limb ischaemia, it has proved to be very effective.