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‘ workplace:
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:
Rozhl. Chir., 2014, roč. 93, č. 6, s. 317-321.
Category:
Original articles
Overview
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
Sources
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2014 Issue 6
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