Abstract:

Aim: was to improve results of a semi-closed loop endarterectomy from the superficial femoral artery (SFA).

Materials and methods: study is based on results of the examination and treatment of 85 patients with obliterating atherosclerosis of lower limbs, who underwent operations in FGBI «Russian Scientific Center of Radiology and Surgical Technologies» Health Ministry from 2008 to 2012.

All patients included in the study were divided into 2 groups :

• Main group - 30 patients operated on by a combination loop endarterectomy with simultaneous implantation of endovascular stent-grafts in SFA .

• The control group - 55 patients operated on a routine procedure loop endarterectomy .

Patients included in the comparison group were matched by gender, age, comorbidity , stage of ischemia and the outflow channel .

Results: The primary patency of the reconstructed area in the main group at 1 year was 73% after 1 years - 63% , cumulative - 76% at 1 year and 70% at 2 years, the limb is stored in 90% of cases (at 1 and 2 years of follow). Patients in the control group remained SFA patency at 1 year in 43% of cases, after 2 years - 32%.

Conclusion: Post-endarterectomy stent placement in SFA significantly improved results of loop endarterectomy

With a diameter of 8 mm and PBA more loop endarterectomy with implantation of stent grafts is a clinically and economically feasible. 

References

1.     Pokrovskiy A.V. Clinical angiology. Part II. M.: Medicina 2004, p.184

2.     National Recommendations for treating patients with Peripheral Arterial Disease. М.: Izdatelstvo NCSSKha im. A.N.Baculeva RAMN, 2010, 78 [In Russ].

3.     Flu H., van der Hage J.H., Knippenberg B. et al. Treatment for peripheral arterial obstructive disease: An appraisal of the economic outcome of complications. J. Vasc. Surg., 2008, 48, 368-376.

4.     TASC Working group. Management of peripheral arterial disease (PAD): TransAtlantic Inter-Society Consensus (TASC). Management Eur. J. Vasc. Endovasc. Surg. 2000; 19 Suppl: 1.

5.     Cotroneo A.R., Iezzi R., Marano G. Hybryd therapy in patients with complex peripheral multifocal stenoobstructive vascular desease: two-year results. Cardio-vasc. Intervent. Radiol., 2007, 30(3), 355-361.

6.     Haimovici H., Ascher E. Haimovici's vascular surgery, fifth ed. Wiley-Blackwell, 2003, 139, 534.

7.     Bockeria L.A., Temrezov M.B., Kovalenko V.I., Chemurziev Surgical treatment of patients with lower limbs arteries atherothrombotic lesions - graft choice for femoral-popliteal anastomosis. Annaly Khirurgii, 2010, 2, 5-8 [In Russ].

8.     Gavrilenko A.V., Skrylev S.I. Surgical management of patients with lower limb critical ischaemia induced by lesions of infrainguinal arteries J.Angiology and vascular surgery, 2008, 14 (3), 111-117 [In Russ].

9.     Morris-Stiff G., D'Souza J., Raman S. Update experience of surgery for acute limb ischaemia in a district general hospital - are we getting any better? Ann. R. Coll. Surg. Engl., 2009, 91(8), 37-40.

10.   Tagelder M.J. Risk factors for occlusion of infrainguinal bypass grafts. Eur. J. Vasc. Endovasc. Surg., 2000, 20(2), 118-124.

11.   Klinkert E.L., Post P.N., Breslau P.J. Saphenous vein versus PTFE for above-knee femoropopliteal bypass. A review of the literature. Eur. J. Vasc. Endovasc. Surg., 2004, 27(4), 357-362.

12.   Rutherford R.B., Baker J.D., Ernst C.J. Recommended standarts for report dealing with lower extremity ischemia: revised version. J. Vasc. Surg., 1997, 26(3), 517-538.

13.   Szilagyi D.E., Smith R.F., Elliott J.P. Infection in arterial reconstruction with synthetic grafts. Ann. Surg., 1972, 176 (3), 321-333.

14.   Pokrovsky A.V., Dan V.N., Zotikov A.E. Femoropopliteal bypass above popliteal fossa with PTFE graft: which graft diameter is better? J. Angiology and vascular surgery, 2008, 14(4), 105-108 [In Russ].