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Vascular Surgery 2019
Journal of Vascular and Endovascular Therapy
ISSN: 2573-4482
Page 52
March 28-29, 2019
Rome, Italy
Vascular Surgery
4
th
Edition of World Congress & Exhibition on
Distal hybrids for long chronic total occlusion of superficial
femoral artery with severely compromised runoff
K Arshed, A Lipin, P Kuryanov, A Antropov, K Atmadzas, A Atmadzas, Y Eminov,
A Borisov, R Sobolev
and
A Orlov
Limb Salvage Center,City hospital no.14, St.Petersburg, Russia
K Arshed et al., J Vasc Endovasc Therapy 2019, Volume 4
DOI: 10.21767/2573-4482-C1-005
Statement of the Problem:
Over two thirds of patients
with critical limb ischemia (CLI) present with superficial
femoral artery (SFA) disease, often a long chronic total
occlusion (CTO) with patient popliteal artery and extensive
occlusive lesions in the crural vessels. We studied a series
of hybrid interventions to treat this multilevel disease as an
alternative to conventional approach (either bypass or PVI).
Methodology & Theoretical Orientation:
A total of 33
patients (24.2% women; mean age 69.5 years), all with
Rutherford class 5-6 disease, were included in the study.
Angiography showed long (>200 mm) SFA CTO in all 33
cases (100%) accompanied by CTO of either all crural
arteries (n=26; 78.8%) or all but the peronea (n=7; 21.2%).
We performed femoropopliteal bypass with autologous vein
in all patients (100%) followed by crural angioplasty done
either no the same day (n=14; 42.4%) or 2-14 days later
(n=19; 52.6%). Direct angiosomic revascularization was
achieved in 30 patients (91%).
Findings:
The in-hospital complications were one death due
to MI (3%); early graft failure in 2 patients (6%; both after
simultaneous hybrid interventions); early major amputation
in one (3%). The 1-year patency and the amputation-free
survival were 66% and 75%, respectively. The 1-year healing
rate was 93.4%.
Conclusion & Significance:
In CLI patients with long SFA
CTO and extensive crural disease a shorter bypass to a
patent popliteal artery followed by crural angioplasty does
not seem to increase the risk of early graft failure and
provides fair long-term outcome.
Recent Publications
1. Walden R, Adar R, Rubinstein Z J and Bass
A (2010) Distribution and symmetry of
arteriosclerotic lesions of the lower extremities:
an arterio-graphic study of 200 limbs.
Cardiovasc Intervent Radiol. 8(4):180-2.
2. Bradbury A W, Adam D J, Bell J, Forbes J F,
Fowkes F G, Gillespie I, Ruckley C V and Raab G
M (2010) basil trial participants. bypass versus
angioplasty in severe ischaemia of the leg
(BASIL) trial: A description of the severity and
extent of disease using the Bollinger angiogram
scoring method and the TransAtlantic Inter-
Society Consensus II classification. J Vasc
Surg. 51(5 Suppl):32S-42S.
3. Davies MG, SaadWE, Peden E K, Mohiuddin I T,
Naoum J J and Lumsden A B (2008) Impact of
runoff on superficial femoral artery endoluminal
interventions for rest pain and tissue loss. J
Vasc Surg. 48(3):619-25.
4. Cotroneo A R, Iezzi R, Marano G et al. (2007)
Hybrid therapy in patients with complex
peripheralmultifocal steno-obstructive vascular
disease: two-year results. Cardiovasc Intervent
Radiol 30:355–361.
5. Zhou M, Huang D, Liu C, Liu Z, Zhang M, Qiao
T and Liu C J (2014) Comparison of hybrid
procedure and open surgical revascularization
for multilevel infrainguinal arterial occlusive