Subintimal Angioplasty: Meta-analytical Evidence of Clinical Utility

Objectives: The aim of this study was to determine accurate estimates of the success rate of subintimal angioplasty in terms of ability to recanalise occluded vessels, patency over time and limb salvage rates. Design: A meta-analysis of published Literature. Materials: All studies reporting unique patient data published in English language between 1989 and 2008. Methods: Separate meta-analyses were performed for immediate technical success, 12-month patency rates and 12-month limb salvage rates. Longer-term outcomes were analyzed in separate meta-analyses. Meta-regression was applied to determine whether any of these outcomes had improved over time. Results: Pooled estimates for technical success, primary patency at 12 months and Limb salvage at 12 months were 85.7% (95% confidence interval: 83.3%-87.7%, 2810 limbs), 55.8% (95% confidence interval: 47.9%-63.4%, 1342 Limbs), and 89.3% (95% confidence interval: 85.5%-92.2%, 2810 limbs), respectively. Regression analysis demonstrated no significant change in outcomes over time. There was some evidence of publication bias, however, after adjusting for this there was little change in the pooled outcome estimates. Conclusions: This study demonstrates that the outcomes for subintimal angioplasty are good and that this method should be considered as an alternative to surgical bypass. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.