Subintimal angioplasty track of the superficial femoral artery: a histological analysis.

Since it was first described in 1990, subintimal angioplasty (SIA) has proven to be a valuable alternative for bypass surgery in patients with atheroocclusive disease of the superficial femoral artery (SFA).1 In this minimally invasive technique, a guidewire is intentionally placed between the intima and the media to create a new track along the vessel wall, bypassing the atherosclerotic occlusion.2 However, to our knowledge, the exact route of this subintimal track has never been confirmed with histopathology. There have been debates about the exact route of the guidewire during this procedure. Bolia et al2 were the first to report on this technique and emphasized that during subintimal passage, the guidewire does not pass the medial layer. On the other hand, Reekers et al3 observed that large, extensive, medial calcifications often result in the inability to perform this technique and concluded that the passage through the medial layer is necessary. Reekers et al, therefore, preferred to call this technique percutaneous intentional extraluminal revascularization. In this case report, we present a patient from whom an endarterectomy specimen of an occluded SFA was obtained 2 months after an SIA procedure, which gave the unique opportunity to study the exact route of the subintimal track using histopathology.