Subintimal angioplasty in the management of lower limb ischaemia.

It is now almost 20 years since subintimal angioplasty (SIA) was pioneered. This cost-effective technique has over the past few years enjoyed a dramatic resurgence of interest and application, particularly after having been identified as a safe and practicable approach to vascular recanalisation in several international publications. Originally used in the femoropopliteal segment, its role has been extended to the treatment of infrapopliteal lesions, including the recanalization of the trifurcation and long tibial occlusions. Experienced centres have repeatedly reported primary success rates of around 90% in the infrainguinal vessels, as well as 1-year limb salvage rates as high as 85% to 90%, and 5-year primary assisted patency rates of 64% whilst not interfering with subsequent vascular surgery. Indeed SIA has not only proved to be very effective in lower limb ischaemia management, both for intermittent claudication and critical ischaemia, but in the last few years it has moved from the shadows and into the limelight of modern endovascular therapy.