[Lower extremity revascularization for long occlusive lesions of femoral and crural arteries].

OBJECTIVE

To assess efficacy of a method of modified open reconstruction of femoral and crural arteries in the absence of an autovein suitable for revascularization.

PATIENTS AND

METHODS

The study included a total of 78 patients subjected to open arterial reconstruction. The duration of the postoperative follow-up amounted to 36 months and more. The patients were divided into 3 groups: Group 1 comprised 18 patients who underwent amodified operation including popliteal distal bypass grafting with an autovein and retrograde (or antegrade) semiclosed loop endarterectomy from the superficial femoral artery; Group 2 was composed of 29 patients subjected to classical femoropopliteal bypass grafting with a reversed great saphenous vein below the knee-joint fissure; and Group 3 consisted of 31 patients who endured X-ray endovascular reconstruction including balloon angioplasty with possible stenting of the superficial femoral artery and popliteal artery.

RESULTS

Primary patency of the arterial bed at 1, 2 and 3 years of follow-up in Group 1 amounted to 80.9% (out of 21 patients), 75% (out of 20 patients) and 72.2% (out of 18 patients), respectively. Secondary patency after 3 years was 100%. The limb salvage rates at 1, 2 and 3 years of follow-up in Group 1 amounted to 90.4% (out of 21 patients), 85% (of 20 patients) and 88.8% (out of 18 patients), respectively. Primary patency at 1, 2 and 3 years of follow-up in Group 2 was 81.3% (out of 33 patients), 76.6% (out of 33 patients) and 68.9% (out of 29 patients), respectively. Secondary patency after 3 years amounted to 80%. The limb salvage rates at 1, 2 and 3 years of follow-up in Group 2 were 87.87% (out of 33 patients), 86.6% (out of 30 patients) and 86.2% (out of 18 patients), respectively. Primary patency of the arterial bed at 1, 2 and 3 years of follow-up in Group 3 amounted to 83.7% (out of 37 patients), 64.7% (out of 34 patients) and 48.3% (out of 31 patients), respectively. Secondary patency after 3 years was 90%. The limb salvage rates at 1, 2 and 3 years of follow-up in Group 3 amounted to 89.1% (out of 37 patients), 85.2% (out of 34patients) and 83.87% (out of 31 patients), respectively.

CONCLUSION

Performing modified open arterial reconstruction by means of the proposed method makes it possible to restore blood flow in the ischemized extremity with a long occlusive lesion of femoral and crural arteries. The remote results (36 months) are suggestive of efficacy of the developed technique.