Authors
Zhdanovich K.V.1, 2, Puzdryak P.D.2, Gusinskiy A.V.1, 2, Shlomin V.V.1, 2, Kucherenko V.S.1, Fionik O.V.1, Danilova D.A.1, Arutyunyan S.O.1
1 Almazov National Medical Research Centre, St. Petersburg, Russia
2 Municipal Multi-Specialty Hospital №2, St. Petersburg, Russia
Abstract
Rationale: The research topic reflects the issues of steno-occlusive lesion of the femoral-popliteal segment and methods of surgical treatment.
Methods: The results of open operations on the femoral-popliteal segment in 141 patients were analyzed. Three study groups were formed: №1 (n = 53) – after remote endarterectomy (RE), №2 (n = 47) – after vein bypass (VBP), № 3 (n = 41) – after polytetrafluorethylene bypass (PTFE). The period of retrospective analysis corresponded to 3, 5 and 10 years of follow-up.
Results: After 3 years, the PP in RE and VBP was 78.4% and 80%, respectively, significantly lower in PTFE – 60,5% (p = 0,085). SP was 86,3%, 88,9%, and 76,3%, respectively. Freedom from reintervation is higher in RE – 54,5%, in bypass surgery groups 33,3% and 30,8%, respectively. The percentage of limb preservation was 94,1% vs 95,5% in the RE and VBP groups, 81,6% in PTFE (p = 0,02). The overall survival rate was 96,2%, 95,7% and 92,7%, respectively. After 5 years, the PP is 43,8% vs 46,3% vs 30,5%. SP is higher in the VBP group – 70,7%, compared with PTFE and RE – 58,3% and 66,6%, respectively. Freedom from reinterpretation is 44,4% vs 27,2% vs 28%, respectively. Limb preservation rates remained high in the RE and VBP groups – 87,5% vs 85%, in the PTFE group – 72,22% (p = 0,075). The survival rate was 90,56%, 87,23% and 87,8%, respectively. By the age of 10, there were no primary passable synthetic shunts. The PP of RE and VBP decreased to 22,2% and 26,3%, respectively (p = 0,006). SP is 53,3% vs 57,9% vs 41,2%, respectively. The frequency of limb preservation is 82,2% vs 76,3% vs 61,8%, respectively (p = 0,058). RE has the highest freedom from reintervation (p = 0,091). The survival rate was 84,9%, 80,8% and 82,9%, respectively.
Conclusion: The advantages of the remote endarterectomy have been revealed in comparison with bypass surgery, slightly inferior to vein bypass in primary patency, which confirms the importance of the method in arterial surgery and opens up new opportunities for reintervations.
Keywords: femoral-popliteal segment, bypass surgery, remote endarterectomy, vein, polytetrafluorethylene.
References
1. Fowkes FGR, Rudan D, Rudan I, Aboyans V, et al. Comparison of global estimates ofprevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013; 382: 1329-40. doi: 10.1016/S0140-6736(13)61249-0.
2. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007; 45S: S5-67. doi: 10.1016/j.jvs.2006.12.037.
3. Gisbertz SS. Remote endarterectomy for arterial occlusive disease. Determinants for success. Thesis, University of Utrecht, with a summary in Dutch. Proefschrift. 2009.
4. Siracuse JJ, Giles KA, Pomposelli FB, Hamdan AD, et al. Results for primary bypass versus primary angioplasty/stent for intermittent claudication due to superficial femoral artery occlusive disease. J. Vasc. Surg. 2012; 55: 1001-7. doi: 10.1016/j.jvs.2011.10.128.
5. Schillinger M, Sabeti S, Dick P, Amighi J, Mlekusch W, et al. Sustained benefit at 2 years of primary femoropopliteal stenting compared with balloon angioplasty with optional stenting. Circulation. 2007; 115: 2745-9. doi: 10.1161/CIRCULATIONAHA.107.688341.
6. Aboyans V, Ricco JB, Bartelink M-LEL, Björck M, Brodmann M, Cohnert T, et al. Editor’s Choice – 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery. 2018; 55(3): 305-368. doi: 10.1016/j.ejvs.2017.07.018.
7. Sharrock M, Antoniou SA, Antoniou GA. Vein Versus Prosthetic Graft for Femoropopliteal Bypass Above the Knee: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Angiology. 2019; 70(7): 649-661. doi: 10.1177/0003319719826460.
8. Klinkert P, Post P, Breslau P, van Bockel J. Saphenous Vein Versus PTFE for Above-Knee Femoropopliteal Bypass. A Review of the Literature. European Journal of Vascular and Endovascular Surgery. 2004; 27(4): 357-362. doi: 10.1016/j.ejvs.2003.12.027.
9. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA et al. 2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J. Am. Coll. Cardiol. 2017; 135, e726-e779. doi: 10.1161/CIR. 0000000000000471.
10. Adedigba JA, Volk AS, Roach HM. Periprosthetic seroma occurrence after femoropopliteal bypass grafting: Surgical management after failure of non-surgical measures in relieving symptoms. Vascular. 2021; 29(2): 244-247. doi: 10.1177/1708538120946546.
11. Gisbertz SS, Tutein Nolthenius RP, de Borst GJ, van der Laan L et al. Remote Endarterectomy Versus Supragenicular Bypass Surgery for Long Occlusions of the Superficial Femoral Artery: Medium-Term Results of a Randomized Controlled Trial (The REVAS Trial). Annals of Vascular Surgery. 2010; 24(8): 1015-1023. doi: 10.1016/j.avsg.2010.03.022.
12. Rabtsun A, Karpenko A, Zoloev DG, Starodubtsev V et al. Remote Endarterectomy and Lamina Vastoadductoria Dissection Improves Superficial Femoral Artery Biomechanical Behavior during Limb Flexion. Annals of Vascular Surgery. 2018; 50: 112-118. doi: 10.1016/j.avsg.2017.12.007.
13. Antoniou GA, Georgiadis GS, Antoniou SA, et al. Bypass surgery for chronic lower limb ischaemia. Cochrane Database of Systematic Reviews. 2017; 34(4): CD002000. doi: 10.1002/14651858.cd002000.pub.
14. Smeets L, Ho GH, Hagenaars T, van den Berg JC, et al. Remote endarterectomy: First choice in surgical treatment of long segmental SFA occlusive disease? European Journal of Vascular and Endovascular Surgery. 2003; 25(6): 583-589. doi: 10.1053/ejvs.2002.1921.
15. Rosenthal D, Martin JD, Schubart PJ, et al. Remote superficial femoral artery endarterectomy and distal aSpire stenting: multicenter medium-term results. J Vasc Surg. 2004; 40(1): 67-72. doi: 10.1016/j.jvs.2004.03.038.
