Kokkinidis Damianos G, Katsaros Ioannis, Jonnalagadda Anil Kumar, Avner Seth J, Chaitidis Nikolaos, Bakoyiannis Christos, Kakkar Amit, Secemsky Eric A, Giri Jay S, Armstrong Ehrin J
Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States; Division of Cardiology, Denver VA Medical Center, University of Colorado, Denver, CO, United States.
Division of Surgery, Medical School, Democritus University of Thrace, Alexandroupoli, Greece.
Cardiovasc Revasc Med. 2020 Jan;21(1):34-45. doi: 10.1016/j.carrev.2019.03.016. Epub 2019 Mar 23.
Subintimal angioplasty (SIA) is often utilized to cross femoropopliteal (FP) artery chronic total occlusions (CTOs). Re-entry devices (RED) can further assist with true lumen re-entry.
To systematically review the literature for studies reporting on the use of SIA, with or without RED.
A systematic review according to the PRISMA guidelines was performed. Quantitative synthesis was applied when possible.
87 studies and 4665 patients (5161 lesions) were included (63.9% male). 46.7% of patients had critical limb ischemia at the time of the intervention. Two RED types were used (Pioneer and Outback). Sixty-eight studies included lesions treated with SIA without RED, 17 studies included lesions treated with RED only, and two studies included a comparison between the two treatment methods. In total, 3898 (83.6%) patients were treated with SIA without RED and 754 (12.2%) with RED. Procedural success rate ranged from 64.5%-100% (92.5% for SIA without RED, 88.3% for RED cases). The complication rate ranged from 1.6% - 28% among different studies (cumulative rates: SIA: 9.1%, RED 9.3%). Perforations occurred in 1.6% of the total population (n = 46). Primary patency at one year ranged from 22% to 94.1%. Newer studies had a higher patency rate, ranging from 70% to 94.1%.
SIA with or without RED is a valuable alternative to intraluminal crossing for endovascular treatment of FP CTOs. Procedural success was excellent for both techniques, while the cumulative complication rate was numerically lower in the RED group. Short- and long-term outcomes were acceptable for both techniques.
内膜下血管成形术（SIA）常用于穿过股腘（FP）动脉慢性完全闭塞病变（CTO）。再入路装置（RED）可进一步辅助进入真腔。
系统回顾关于使用SIA（无论有无RED）的研究文献。
按照PRISMA指南进行系统回顾。尽可能进行定量综合分析。
纳入87项研究和4665例患者（5161处病变）（男性占63.9%）。46.7%的患者在干预时患有严重肢体缺血。使用了两种RED类型（先锋和远郊）。68项研究纳入了仅用SIA治疗的病变，17项研究纳入了仅用RED治疗的病变，两项研究纳入了两种治疗方法的比较。总体而言，3898例（83.6%）患者仅接受SIA治疗，754例（12.2%）接受RED治疗。手术成功率在64.5% - 100%之间（仅用SIA治疗为92.5%，RED治疗病例为88.3%）。不同研究中的并发症发生率在1.6% - 28%之间（累积发生率：SIA为9.1%，RED为9.3%）。穿孔发生在1.6%的总人群中（n = 46）。一年时的原发性通畅率在22%至94.1%之间。较新的研究通畅率较高，在70%至94.1%之间。
无论有无RED，SIA都是腔内穿过技术用于FP CTO血管内治疗的有价值替代方法。两种技术的手术成功率都很高，而RED组的累积并发症发生率在数值上更低。两种技术的短期和长期结果均可接受。
