Abstract

This study presents an overview of modern methods of surgical and endovascular treatment of atherosclerotic lesions of the superficial femoral artery

Aim: was to analyze the state of surgical and endovascular treatment of atherosclerotic lesions of the superficial femoral artery according to the modern literature in the field of vascular surgery

Results: this review analyzes more than 30 relevant publications presented in both domestic anc foreign press over the past 20 years, taking into account a variety of meta-analyses.

Conclusions: this topic is very relevant today, as the increase in the number of surgical and endovascular interventions in lesions of the superficial femoral artery dictates new research to develop optimal tactics of treatment of this category of patients.

References 

1.     Pokrovskij A.V. The state of vascular surgery in 2017. Moskva 2018. [In Russ.]

2.     Pokrovskij A.V. Clinical angiology. Guide-book for physicians. M.: Medicina. 2004; 2: 184 [In Russ.]

3.     Diamantopoulos A, Katsanos K. Treating femoropopliteal disease: established and emerging technologies. Semin Intervent Radiol. 2014 Dec; 31(4):345-52.

4.     Dominguez A, Bahadorani J, Reeves R, et al. Endovascular therapy for critical limb ischemia. Expert Rev Cardiovasc Ther. 2015 Apr; 13(4): 429-44.

5.     Bokeriya L.A., Temrezov M.B., Kovalenko V.I., i dr. Actual problems of surgical treatment of patients with critical ischemia of lower limbs - solutions (state of the problem). Annalyhirurgii. 2011; 1: 5-9. [In Russ.]

6.     Norgen L, Hiatt WR, Dormandy JA. et al. Inter-Society Consensus for the management of Peripheral Arterial Disease (TASC II). Eur. J. Vasc. Endovasc. Surg. 2007; 3(1): 1-75.

7.     Cotroneo AR, Iezzi R, Marano G. Hybryd therapy in patients with complex peripheral ultifocal steno-obstructive vascular disease: two-year results. Cardiovasc. Intervent. Radiol. 2007; 30: 355-361.

8.     Bokeriya L.A. Endovascular surgery of diseases of great vessels. M.:NCSSKH im. A.N. Bakuleva RAMN, 2008;291-310. [In Russ.]

9.     Gavrilenko A.V., Kotov A.E., Murav'eva YA.YU. The effect of tactical errors on results of surgical treatment in patients with critical lower limb ischemia. Angiologiya i sosudistaya hirurgiya. 2010; 16(1):138-143. [In Russ.]

10.   Marston WA, Davies SW, Armstrong В, Farber MA, Mendes RC, Fulton JJ, Keagy BA. Natural history of limbs with arterial insufficiency and chronic ulceration treated without revascularization. J Vase Surg. 2006 Jul; 44(1): 108-114.

11.   Kazakov YU. I., Lukin I. B., Kazakov A. YU. The choice of vascular reconstruction method for critical lower limb ischemia. Angiologiya i sosudistaya hirurgiya. 2015;21(2):152-8.

12.   Bied Dzh. D. Amputation or reconstruction for critical lower limb ischemia. Angiologiya i sosudistaya hirurgiya. 1998;4(1): 72-78. [In Russ.]

13.   Pokrovskij A.V. Russian consensus. Diagnosis and treatment of patients with critical lower limb ischemia. M., Shwarz Pharma, 2002; 40 s. [In Russ.]

14.   Linkert P. et al. Saphenous Vein Versus PTFE for Above-Knee Femoropopliteal Bypass. A Review of the Literature. Eur. J. Vasc. Endovasc. Surg. Elsevier BV. 2004; 27(4): 357-362.

15.   Abramov S.I., Majtesyan D.A., Lazaryan T.A. Longterm results with a semi-closed endarterectomy loop from the superficial femoral artery and femoral-popliteal bypass grafting. Angiologiya i sosudistaya hirurgiya. 2014; 20(4): 147-151 [In Russ.]

16.   Beard JD: which revascularization is best for critical limb ischemia: endovascular or open surgery? J Vasc Surg. 2008, 48: 112-116S. 10.1016 / j.jvs.2008.01.065.

17.   Blevins WA, Schneider PA: Endovascular treatment of critical limb ischemia. Eur J Vasc Endovasc Surg. 2010; 39 (6): 756-761. 10.1016 / j.ejvs.2010.02.008.

18.   Adam DJ, Beard JD, Cleveland T, et al: BASIL trial participants. Shunting and angioplasty in severe ischemia of the foot (basil): a multicenter, randomized controlled trial. Lancet. 2005, 366 (9501): 1925-1934.

19.   Bradbury AW, Adam DJ, Bell J, et al. Bypass versus Angioplasty in Severe Ischemia of the Leg (BASIL) trial: An intention-to-treat analisys of amputation-free and overall survival in patients randomized to a bypass surgery-first or a ballon angioplasty-first revascularization strategy. J. Vasc. Surg. 2010; 51: 5-17.

20.   Lindgren H, Qvarfordt P, Ekesson M, et al Primary Stenting of the Superficial Femoral Artery in Intermittent Claudication Improves Health Related Quality of Life, ABI and Walking Distance: 12 Month Results of a Controlled Randomised Multicentre Trial. Eur J Vasc Endovasc Surg. 2017        May; 53(5):686-694.

21.   Grimme FA., Goverde PA., Van Oostayen JA., et al. Covered stents for aortoiliac reconstruction of chronic occlusive lesions. J. Cardiovasc. Surg. (Torino). 2012; 53 (3):279-89.

22.   Gandini R, Fabiano S, Chiocchi M, et al. Percutaneous treatment in iliac artery occlusion: long-term results. Cardiovasc. Intervent. Radiol. 2008; 31 (6): 1069-76.

23.   Yokoi Y How should recent endovascular trials for femoropopliteal artery disease be interpreted. Cardiovasc Interv Ther. 2017 Apr; 32(2):106-113.

24.   Deloose K, Callaert J. Less is more: the "As Less As Reasonably Achievable Stenting" (ALARAS) strategy in the femoropopliteal area. J Cardiovasc Surg (Torino). 2018 Aug; 59(4):495-503.

25.   Chalmers n Walker PT, Belly AM et al. A randomized study of a smart stent versus balloon angioplasty for long superficial lesions of the femoral artery: a super-study. Cardiovascular and Interventional Radiology. 2013; 36 (2): 353-361

26.   Dake MD. et al. Durable Clinical Effectiveness With Paclitaxel-Eluting Stents in the Femoropopliteal ArteryCLINICAL PERSPECTIVE. Circulation. Ovid Technologies (Wolters Kluwer Health), 2016;133(15): 1472-1483.

27.   Muradin GSR, Bosch Denpasar, Stainen T, Hunink MGM. Balloon dilatation and stent implantation for the treatment of arterial disease of the femur: Meta-analysis. Radiology. 2001; 221 (1): 137-145.

28.   Acin F, de Haro J, Bleda S,et al Primary nitinol stenting in femoropopliteal occlusive disease: a meta-analysis of randomized controlled trials. J Endovasc Ther. 2012 Oct;19(5):585-95. doi: 10.1583/JEVT-12-3898R.1.

29.   Zatevahin         I.I., SHipovskij V.N., Tursunov S.B. i dr. Longterm results of angioplasty using drug-coated balloons for lesions of the femoral-popliteal segment. Angiologiya i sosudistaya hirurgiya. 2014; 20(4): 64-68. [In Russ.]

30.   Katsanos to Karnabatidis D. Kitrou P Spiliopoulos with Christeas H Siablis D. Paclitaxel-coated balloon angioplasty and a conventional dilatation balloon for treatment of non-dialysis access: 6-month interim results from a prospective randomized controlled trial. Journal of Endovascular Therapy. 2012; 19 (2): 263-272.

31.   Werk M, Albrecht T, Dirk-Roelfs Meyer D-R, et al. Paklitaxel-Coated Balloons Reduse Restenosis After Femoropopliteal Angioplasty. Circ. Cardivasc. Interv. 2012; 5:831-840.

32.   Fanelli F, Cannavale A, Boatta E, et al. Lower limb multilevel treatment with drug-eluting balloons: 6-month results from the DEBELLUM randomized trial. J Endovasc Ther. 2012; 19: 571-580.

33.   Diamantopoulos A, Gupta Y, Zayed H. et al Paclitaxel-coated balloons and aneurysm formation in peripheral vessels. J Vasc Surg 2014; epub ahead of print.

34.   Pastromas G, Katsanos K, Krokidis M, et al Emerging stent and balloon technologies in the femoropopliteal arteries. Scientific World Journal. 2014; 2014:695402.

35.   Schmidt A, Piorkowski M, Werner M, et al: First experience with drug-eluting balloons in infrapopliteal arteries: restenosis rate and clinical outcome. J Am Coll Cardiol. 2011; 58 (11): 1105-1109. 10.1016/j.jacc. 2011.05.034.

36.   Fanelli F, Cannavale A, Boatta E, et al: Lower limb multilevel treatment with drug-eluting balloons: 6-month results from the DEBELLUM randomized trial. J Endovasc Ther. 2012; 19 (5): 571-580. 10.1583/JEVT-12-3926MR.1.

37.   Liistro F, Porto I, Angioli P, et al: Drug-eluting balloon in peripheral intervention for below the knee angioplasty evaluation (DEBATE-BTK): a randomized trial in diabetic patients with critical limb ischemia. Circulation. 2013.

38.   Bays S. The use of scoring balloons in the superficial femoral artery. J Cardiovasc Surg (Torino). 2018 Aug; 59(4):504-511.

39.   Saxon rubles. Heparin bonded stent grafts in SFA: VIPER annual results. The report is presented at the International Symposium on Endovascular Therapy; January 18, 2012; Miami, Fla, USA.

40.   Ansel G. 3-year vivid results. The document is available at: Vascular InterVentional Advances; October 2011; Las Vegas, Nev, USA.

41.   Vermassen F. Bouckenooghe I, Morel N Goverde P. Schroe N. The role of biodegradable stents in the superficial femoral artery. Journal of Cardiovascular Surgery. 2013; 54 (2): 225-234.

Abstract:

Aim: was to show the role and possibilities of 128-slice computed tomography (MSCT) iirfhe dynamic observation of patients; after open and endovascular surgery of lower limb's arteries;

Material and methods: 1st group - 36 patients (30,5%) who (underwent endovascular procedures;, 2nd group - 51 patients; (44,2%) who underwent open reconstructive operations;, 3rd group - 31 patients; (26,3%) after hybrid operations;. 108 patients; were examined in post-operative period (7 women, 101 men), average age was 57,28±15,08. All patients underwent MSCT-angiography on the background of the contrast bolus;. 55 patients; had standard procedure, other patients; underwent examination with low-close protocol.

Results: obtained images of low-close protocol had satisfactory condition of information: arterial walls were visualized well, inner lumen and para-prosthesis space, atherosclerotic lesions were also visualized. Obtained results of MSCT-angiography during low-dose protocol were confirmed ntraoperatively Obtained data of MSCT-angiography: all patients; of 1st group had passable stents; but 2 patients; who had hernodynarnically non-significant stenosis. In 2nd group 5 patents; had restenosis of prosthesis and grafts;, 20 patients; had thrombosis. In 3rd group, 2 patients; had restenosis of prosthesism femoral-popliteal segment, 13 patient had thrombosis of prosthesis/grafts, 6 patients; had restenosis of stents;, 1 patient had stent thrombosis in femoral-popliteal segment, n case of hernodynarnically significant stenosis (50%) of the stent or prosthesis in the absence of clinical manifestations; we made correction of drug therapy. If the patent had a detected boundary stenosis (50-74%) with the absence of complaints;, the patient had correction of drug therapy, with the appointment of a dynamic MSCT-angiography in 3-6 months. Patents; with occlusion of the prosthesis, or a stent with a satisfactory distal vessels clue to good collaterals; we performed thrombectomy or repeated prosthetics. Patients who according to the MDCT-angiography, had identified thrombosis of prosthesis/grafts with poor distal vessels, absence of good collaterals; and the presence of clinical manifestations; of critical ischemia - amputation of the affected limb.

Conclusion: MSCT-angiography is a highly informative method of nornnvasive imaging of patency of stent, prosthesis/graft of mam arteries; of lower limbs;. Our study showed that using of a low-close protocol is; possible for the dynamic monitoring of patents; for the detection of postoperative complications;, early diagnosis and prevention of restenosis and thrombosis of prosthesis/grafts and stents Timely diagnosis of stenosis of stents; or grafts/prostheses of mam arteries; of lower limbs can determine tactics; and stages; of surgery (endovascular treatment, and re-open reconstructive vascular surgery, thrombectomy), not leading to the patient’s; disability. 

References

1.     Bokerija, L. A., Gudkova R.G. Serdechno-sosudistaja hirurgija - 2010. Bolezni i vrozhdennye anomalii sistemy krovoobrashhenija: Prakticheskoe rukovodstvo[Pathology and congenital anomalies of circulatory system. Practical guide-book]. M.: NCSSH im. A. N. Bakuleva RAMN. 2011; 191 c [In Russ].

2.     Pokrovskij A.V., Doguzhieva R.M., BogatovJu.P., i dr. Otdalennye rezul'taty aorto-bedrennyh rekonstrukcij u bol'nyh saharnym diabetom 2 tipa[Late outcomes of aorto-femoral reconstructions in patients with diabetes mellitus type 2]. Angiologija i sosudistajahirurgija. 2010; 16 (1): 48-52[In Russ].

3.     Poljancev A.A., Mozgovoi P.V., Frolov D.V., i dr. Trombofilicheskie sostojanija v patogeneze pozdnih tromboticheskih reokkljuzij u bol'nyh obliterirujushhim aterosklerozom arterii nizhnih konechnostej [Thrombofillic conditions in pathogenesis of late thrombotic occlusions in patients with atherosclerosis of lower limbs]. Vestnik jeksperimental'noj i klinicheskoj hirurgii. 2011; 2 (4): 208-211[ In Russ].

4.     Kokov L.S. Luchevaja diagnostika bolezni serdca i sosudov: nacional'noe rukovodstvo. [Radiodiagnostics of heart and vessels pathology. National guide-book] M.: GJeOTAR- Media. 2011; 688 [In Russ].

5.     Bokerija, L.A., AlekjanB.G. Rukovodstvo rentgenjendovaskuljarnoj hirurgii serdca i sosudov 3t [Guide-book of endovascular surgery of heart and vessels. Volume 3]. M: NCSSH im. A.N. Bakuleva RAMN. M. 2013; 598 [In Russ].

6.     Diagnosticheskajaj effektivnost' mul'tisrezovoj komp'juternoj tomografii-angiografii v dinamicheskom nabljudenii pacientov posle rekonstruktivnyh vmeshatel'stv na magistral'nyh arterij nizhnih konechnostej [Diagnostic efficacy of multislice computed tomographic angiography in dynamic post-operative supervision after reconstrictive procedures on main arteries of lower limbs]. MedicinskijvestnikMVD. 2014; 6 (73): 47-49[In Russ].

7.     Kayhan A., Palab y k F., Serinsoz S. et а!. Multidetector CT angiography versus arterial duplex USG in diagnosis of mild lower extremity peripheral arterial disease: is multidetectorCT a valuable screening tool? Eur. J. Radiol. 2012; 81(3): 542-546.

8.     Mamet'eva I.A., Miheev N.N. Diagnosticheskajaj effektivnost' mul'tisrezovoj komp'juternoj tomografii-angiografii v dinamicheskom nabljudenii pacientov posle rekonstruktivnyh vmeshatel'stv na magistral'nyh arterijah nizhnih konechnostej [Diagnostic efficacy of multislice computed tomographic angiography in dynamic post-operative supervision after reconstrictive procedures on main arteries of lower limbs]. Medicinskij vestnik MVD. M. 2015; 78 (5): 42-47[ In Russ].

9.     lezzi R., Santoro M., Dattesi R., et al. Diagnostic accuracy of CT angiography in the evaluation of stenosis in lower limbs: comparison between visual score and quantitative analysis using a semiautomated 3D software. J. Comput. Assist. Tomogr. 2013; 37 (3): 419-425.

10.   Pomposelli F. Arterial imaging in patients with lower-extremity ischemia and diabetes mellitus. J. Am. Podiatr. Med. Assoc. 2010; 100 (5): 412-23.

11.   Mamet'eva I.A., Miheev N.N., Obel'chak I.S. i dr. Primenenie nizkodozovogo protokola u pacientov posle rekonstruktivnyh vmeshatel'stv na magistral'nyh arterijah nizhnih konechnostej. Nash opyt[Low-dose protocol in patients after reconstructive procedures on main arteries of lower limbs]. REJR. Materialy IX Vserossijskogo kongressa luchevyh diagnostov i terapevtov «Radiologija 2015».M. 2015; 5 (2): 69 [ In Russ]

12.   Mahnken A.H., Bruners P., Mommertz G. Et al. Carbon dioxide contrast agent for CT arteriography: results in a porcine model. J. Vasc.Interv. Radiol. 2008; 19 (7):1055-1064.

13.   Mizuno A., Nishi Y, Niwa K. Total bowel ischemia after carbon dioxide angiography in a patient with inferior mesenteric artery occlusion. Cardiovasc. Interv. Ther. 2014; 6(3): 642-650.