Comparison between femoropopliteal bypass and subintimal recanalization in the treatment of critical limb ischaemia
Authors:
J. Fialová 1; P. Utíkal 1; M. Köcher 2; M. Černá 2; J. Indráková 1; P. Bachleda 1
Authors place of work:
II. chirurgická klinika FN Olomouc, přednosta: Prof. MUDr. P. Bachleda, CSc.
1; Radiologická klinika FN Olomouc, přednosta: Prof. MUDr. M. Heřman, Ph. D.
2
Published in the journal:
Rozhl. Chir., 2014, roč. 93, č. 6, s. 317-321.
Category:
Original articles
Summary
Introduction:
Revascularization of occlusion of the femoropopliteal region in patients with critical limb ischaemia (CLI) may be performed following the standard surgical approach using bypass with the saphenous vein graft (FP bypass). Unfortunately, up to 40% of these patients do not have a suitable saphenous vein. In these patients, revascularization may be performed surgically using bypass with prosthesis, allograft vein or by interventional radiological methods. An endovascular alternative is represented by subintimal recanalization (SIR).
Material and methods:
Our prospective analysis evaluated mid-term results of revascularization using FP bypass or SIR in patients with occlusion of the femoropopliteal region and CLI. Our aim was to answer the question whether SIR can fully replace FP bypass in certain indications.
From January 2010 to December 2012, 59 revascularizations of the CLI (Rutherford 5-6) with comparable SFA occlusion were performed. We monitored the immediate postoperative course, technical and clinical success and the process of healing of the defect.
Results:
Healing of the defect was achieved in 78.6% of patients with FP bypass using the saphenous vein, in 62.5% of patients with FP bypass using prosthesis and in 64.9% of patients with SIR (P=0.578). When comparing the bypass group, which was subdivided into a group with revascularization using autologous vein and a group with revascularization using ePTFE prosthesis, with the SIR group, primary patency was evaluated. The results for vein 78.0% after 6, 12, 24 and 36 months, for prosthesis 74.5%, 55%, 55% after 6, 12 and 24months, and for the SIR group 78%, 60%, 51.3% and 50.7% after 6,12,24 and 36 months. When comparing the results of the groups, no statistically significant difference was found (P =0.625).
Conclusion:
As expected, the most successful method of choice is revascularization by FPB using the saphenous vein. SIR and FP bypass using prosthesis had similar results with respect to healing of the defects.
Key words:
femoropopliteal bypass – subintimal recanalization – critical limb ischaemia
Zdroje
1. Klinkert P, Post PN, Breslau PJ, Bockel JH. Saphenous Vein Versus PTFE for Above-Knee Femoropopliteal Bypass. A review of the Literature Eur J Vasc Endovasc Surg 2004;27:357–62.
2. Ruherford RB, Baker DJ, Ernst C, Johnston KW, Porter JM, et al. Recommended standarts for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997;26:517–38.
3. Met R, van Lieden KP, Koelemay MJ, Bipat S, Legemate DA, et al. Subintimal angioplasty for peripheal arterial occlusive disease: A systematic review. Cardiovasc Intervent Radiol 2008;31: 687–97.
4. London NJ, Srinivasan R, Naylor AR, Hartshorne T, Ratliff DA, et al. Subintimal angioplasty of femoropopliteal occlusions: the long term results. Eur J Vasc Surg 1994;8:148–55.
5. Bown MJ, Bolia A, Sutton AJ. Subintimal angioplasty: meta-analytical evidence of clinical utility. Eur J Vasc Endovasc Surg. 2009;38:323–37.
6. Lipsitz EC, Ohki T, Veith FJ, Suggs WD, Wain RA, et al. Does subintimal angioplasty have a role in the treatment of severe lower extremity ischemia? J Vasc Surg 2003;37:386–91.
7. Köcher M, Černá M, Utíkal P, Kozák J, Šišola I, et al. Subintimální angioplastika ve femoropopliteální oblasti – střednědobé výsledky. Ces Radiol 2008;62:153–9.
8. Aalders GJ, van Vroonhoven TJ. Polytetrafluoroethylene versus human umbilical vein in above-knee femoropopliteal bypass: six-year results of a randomized clinical trial. J Vasc Surg 1992; 16:816–23.
9. Pedersen G, Laxdal E, Hagala M, Amundsen SR, Dregelid E, et al. The impact of patient characteristics on long-term results of above-knee prosthetic femoropopliteal bypass for critical ischemia. Int Angiol 2005;24:349–54.
10. Kavanagh EG, OęRiordain DS, Buckley DJ, OęDonnell JA. Long term results of polytetrafluoroethylene in above knee femoropopliteal bypass for critical ischaemia.Ir J Med Sci 1988;167:221–4.
11. Dorrucci V, Griselli F, Petralia G, Spinamano L, Adornetto R. Heparin-bonded expanded polytetrafluoroethylene grafts for infragenicular bypass in patients with critical limb ischemia: 2-year results. J Cardiovasc Surg 2008;49:145–9.
12. Pereira CE, Albers M, Romiti M, Brochado-Neto FC, Pereira CA. Meta-analysis of femoropopliteal bypass grafts for lower extremity arterial insufficiency. J Vasc Surg 2006;44:510–17.
13. Farber A, Major K, Wagner WH, et al. Cryopreserved saphenous vein allografts in infrainguinal revascularization: analysis of 240 grafts. J Vasc Surg 2003;38:15–21.
14. DeLuccia N, Brochado-Neto FC, Romiti M, Kikichi M, dos Reis JM, et al. Preferential use of nonreversed vein grafts in above-knee femoropopliteal bypasses for critical ischemia: midterm outcome. Ann Vasc Surg 2008;22:668–75.
15. Korhonen M, Biancari F, Söderström M, Arvela E, Halmesmäki K, et al. Femoropopliteal balloon angioplasty vs. bypass surgery for CLI: a propensity score analysis. Eur J Vasc Endovasc Surg 2011;41:378–84.
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Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
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