To the content
3 . 2022

Immediate and medium-term results of repeated open interventions in patients with occlusion of autovenous femoro-paplinear bypass

Abstract

The management of patients with occlusion of the autovenous femoral-popliteal bypass has not yet been determined.

The aim is to analyze the immediate and medium-term results of various surgical strategies in patients with occlusion of autovenous femoral-popliteal bypass.

Material and methods. There are results of treatment of 57 patients, which were operated on for occlusion of autovenous femoral-popliteal bypass. The patients were divided into 2 clinical groups according to the type of repeated surgery performed: 37 patients underwent repeated autovenous femoral-popliteal bypass grafting, they constituted the 1st group; 20 patients underwent endarterectomy from the common femoral artery with profundoplasty; they were included in the 2nd group. The groups did not differ in the incidence of concomitant pathology. The distance of painless walking among patients of the 1st group was 35.95±14.88 m, in the 2nd – 39.50±17.90 m.

Results. The average duration of surgical interventions in the 1st group was 270±26 min, in the 2nd – 210±21 min. Blood loss in the 1st group was 214.86±77.77 ml, in the 2nd – 62.50±15.17 ml (p=0.002). Technical success was achieved in 34 (91.89%) patients of the 1st group and in 17 (85%) patients of the 2nd group. Healing of trophic ulcers in patients after repeated femoropopliteal bypass was observed more often than after femoroprofundoplasty (92.3 vs 14.3%, p=0.001). Thrombosis of the operated segment within the first 12 months after surgical treatment was more often observed in patients of the 1st group (13.5 vs 5%). Minor amputations (at the foot level) during the first 12 months after reoperation were performed in 2 (3.5%) patients.

Conclusion. Rebypass surgery of the hip is characterized by good short and medium term results.

Keywords:femoropopliteal bypass; bypass occlusion; reoperation

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Artemova A.S., Komakha B.B., Chernyavskiy M.A. Immediate and medium-term results of repeated open interventions in patients with occlusion of autovenous femoro-paplinear bypass. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (3): 7–12. DOI: https://doi.org/10.33029/2308-1198-2022-10-3-7-12  (in Russian)

References

1.     National guidelines for the diagnosis and treatment of diseases of the arteries of the lower extremities. In: National Clinical Guidelines. Moscow, 2019. (in Russian)

2.     Conte M.S., Bradbury A.W., Kolh P., et al. Global (ESVS, SVS, WFVS) vascular guidelines on CLTI management. Eur J Vasc Endovasc Surg. 2019; 58: S1–109.

3.     Glushkov N.I., Ivanov M.A., Puzdryak P.D., Samko K.V., Artemova A.S., Uryupina A.A. The choice of revascularization method in elderly and senile patients with infrainguinal arterial disease. Uspekhi gerontologii [Advances of Gerontology]. 2019; 32 (5): 758–64. (in Russian)

4.     Özpak B., Çayır M.Ç. Drug-eluting balloon treatment in femoropopliteal in-stent restenosis of different lengths. Turk Gogus Kalp Damar Cerrahisi Derg 2020; 28 (3): 460–6. DOI: https://doi.org/10.5606/tgkdc.dergisi.2020.18980  

5.     AbuRahma A.F. When are endovascular and open bypass treatments preferred for femoropopliteal occlusive disease? Ann Vasc Dis. 2018; 11 (1): 25–40. DOI: https://doi.org/10.3400/avd.ra.18-00001  

6.     Melillo E., Micheletti L., Nuti M., et al. Long-term clinical outcomes in critical limb ischemia – a retrospective study of 181 patients. Eur Rev Med Pharmacol Sci. 2016; 20 (3): 502–8.

7.     Ito R., Kumada Y., Ishii H. Clinical outcomes after isolated infrapopliteal revascularization in hemodialysis patients with critical limb ischemia: endovascular therapy versus bypass surgery. J Atheroscler Thromb. 2018; 25 (9): 799–807. DOI: https://doi.org/10.5551/jat.42648  

8.     Meecham L., Popplewell M., Bate G., et al. Contemporary (2009–2014) clinical outcomes after femoro-popliteal bypass surgery for chronic limb threatening ischemia are inferior to those reported in the UK bypass versus angioplasty for severe ischemia of the leg (BASIL) trial (1999-2004). J Vasc Surg. 2019; 69 (6): 1840–7. DOI: https://doi.org/10.1016/j.jvs.2018.08.197   

9.     Altreuther M., Mattsson E. Long-term limb salvage and amputation-free survival after femoropopliteal bypass and femoropopliteal PTA for critical ischemia in a clinical cohort. Vasc Endovasc Surg. 2019; 53 (2): 112–7. DOI: https://doi.org/10.1177/1538574418813741  

10. Robinson W.P., Mehaffey J.H., Hawkins R.B., et al. Lower extremity bypass and endovascular intervention for critical limb ischemia fail to meet Society for Vascular Surgery’s objective performance goals for limb-related outcomes in a contemporary national cohort. J Vasc Surg. 2018; 68 (5): 1445–6. DOI: https://doi.org/10.1016/j.jvs.2018.03.413

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

Journals of «GEOTAR-Media»