OBJECTIVE: We assessed the technical success, safety, and short-term effectiveness of percutaneous intentional extraluminal recanalization (PIER) in @entity1 with limb-threatening @entity63 and no autologous vein or with a major contraindication to surgery. METHODS: From 1999 through 2002, 25 @entity1 with femoropopliteal occlusion and @entity158 or tissue loss underwent PIER. Thirteen @entity1 had undergone one or more failed bypass surgeries in the treated lower extremity, and no @entity1 had suitable vein for bypass grafting. In four @entity1 the ejection fraction was less than 15%; four @entity1 had severe nonreconstructable @entity453 ; and two @entity1 with @entity5 refused amputation. All @entity1 underwent subintimal wire placement, followed by percutaneous transluminal angioplasty and intracoil stent placement. Occlusions ranged in length from 6 to 18 cm, and 1 to 10 stents were placed. Technical success required no residual stenosis greater than 30% on arteriography, velocity ratio less than 1.5 on duplex ultrasound scanning, and improvement in ankle-brachial index of 0.15 or greater. Follow-up duplex scanning was performed every 3 months. RESULTS: Initial success was obtained in 23 of 25 @entity1 (92%), with ankle-brachial index improvement of.31 to.54. All successful procedures resulted in symptomatic improvement. Mean follow-up was 13.3 months (range, 4-30 months). During follow-up, 10 @entity1 died and 2 arteries demonstrated recurrent occlusion. With life table analysis, success rate was 92% at 12 months. Of the 4 @entity1 in whom the procedure failed, 3 required major amputation and symptoms persisted in one. Complications occurred after two procedures, one @entity583 and one groin @entity1410 . CONCLUSIONS: PIER is technically possible in @entity1 with femoropopliteal occlusion, and the procedure is associated with a low complication rate. Most procedures provide at least short-term clinical success and have enabled successful wound healing and @entity158 relief in @entity1 without other effective options. Further studies and longer follow-up are required to determine long-term success and the role of PIER in treatment of femoropopliteal occlusion.

Treatment of limb-threatening XXXX with percutaneous intentional extraluminal recanalization: a preliminary evaluation.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction'] @entity63 :: ('MESH:D007511', 'Disease') :: ['ischemia'] @entity5 :: ('MESH:D009369', 'Disease') :: ['metastatic cancer'] @entity1410 :: ('MESH:D006406', 'Disease') :: ['hematoma'] @entity158 :: ('MESH:D010146', 'Disease') :: ['rest pain', 'pain'] @entity453 :: ('MESH:D003324', 'Disease') :: ['coronary artery disease']
@entity63 :: (MESH:D007511,Disease) :: ['ischemia']
