ABSTRACT
Since the first description of percutaneous endoluminal treatment by Dotter in 19641 and subsequent development of the balloon catheter and its application by Gruntzig in 1974,2 the treatment of peripheral vascular disease has been transformed. Percutaneous transluminal angioplasty (PTA) has been employed extensively in the treatment of peripheral vascular disease, with a highly successful outcome.3-10 However, the results of recanalization of long occlusions have been perceived to be poor in terms of primary success rates and long-term outcome.3,4 Conventionally, occlusions of the superficial femoral artery (SFA) or the popliteal artery of more than 10 cm or flush occlusions of the SFA have been treated by a surgical bypass. Since the development of the technique of subintimal angioplasty,11 the vast majority of the occlusions can be treated, whether they are full-length occlusions of the superficial femoral artery or flush occlusions.12-17 Tibial artery occlusions can be treated successfully in the majority of cases,18-20 thusmaking an impact onthetreatment of critical limb ischaemia where the disease tends to be distal.21, 22
Extraluminal angioplasty, commonly known as percutaneous subintimal angioplasty (PSA), has been experienced accidentally by most operators. However, there have only been a few reports of intentional extraluminal recanalization. Following the first reports of recanalizations through a dissection with a laser probe23, 24 and an early report in the form of a letter to the editor,25 the first significant publication occurred in 1990, presenting the experience of 71 procedures.11 A number of reports has since been published, which has included the experience of recanalization of femoropopliteal occlusions in the majority of cases.11-16 However, the procedure has also been extended to crural artery occlusions,18-21 iliacocclusions,26,28 and, in some cases, common femoral, profunda, subclavian and brachial artery occlusions.29
