Application of Combined Superficial Femoral Artery Stenting and Deep Femoral Artery Profundoplasty in Chinese Patients With Lower Extremity Artery Disease.

Guoqing Chi,Mingchao Ding

doi:10.3389/fsurg.2021.646978

Abstract

Objective: Lower extremity artery disease (LEAD) increases sharply with age and results in severe burden in individuals and in society. This study aimed to compare the efficiency of simple superficial femoral artery stenting (SFAS) and the hybrid operation, such as combined SFAS and deep femoral artery profundoplasty (DFAP), in the treatment of Chinese patients with LEAD, classified as Rutherford grades 3–5.Methods: There were 200 patients with LEAD classified as Rutherford grades 3–5 included in the simple SFAS group (n = 100) and the combined SFAS and DFAP group (n = 100).Results: All the patients had median age of 71 years, and there were 143 males (71.5%). Not only the increase rate of ankle brachial index (ABI), but also reduction rate of Rutherford grade, were significantly higher after surgery in the combined SFAS and DFAP group than in the simple SFAS group (P < 0.05 for all). The patency rate of patients in the combined SFAS and DFAP group was significantly higher than that of patients in the simple SFAS group during the follow-up (P < 0.05). Proportion of amputation and claudication distance <200 m had no significant difference between the two groups during the 2-year follow-up (P > 0.05 for all).Conclusion: This study demonstrated that, compared with SFAS, combined SFAS and DFAP improved not only the ABI and the Rutherford grade after surgery but also the patency rate during the follow-up in Chinese patients with LEAD. Hybrid operation has significant value in alleviating clinical symptoms after surgery, and, thereby, improving vascular prognosis in Chinese patients.

Highlights

Arteriosclerosis accounts for 60–80% of lower extremity artery disease (LEAD), and results in severe burden in individuals and in society [1, 2]
In accordance with ESC Guidelines on the diagnosis and treatment of peripheral artery diseases, all the patients were included based on the following criteria: 1) LEAD diagnosed by chief physicians; 2) Rutherford grades 3, 4, and 5; 3) occlusive length of superficial femoral artery >15 cm; 4) initial stenosis of deep femoral artery >30%; 5) stenosis of iliac artery
This study demonstrated that compared with superficial femoral artery stenting (SFAS), combined SFAS and deep femoral artery profundoplasty (DFAP) improved ankle brachial index (ABI) and Rutherford grade after surgery, and patency rate during the follow-up in the Chinese patients with LEAD

Summary

Introduction

Arteriosclerosis accounts for 60–80% of lower extremity artery disease (LEAD), and results in severe burden in individuals and in society [1, 2]. Due to bifurcation of SFAS and DFAP in LEAD common femoral artery caused by some lesions, SFAS frequently has adverse effects on deep femoral artery and is accompanied by in-stent restenosis [4]. In these patients, deep femoral artery profundoplasty (DFAP) can improve collateral branches and increase blood supply, but not restore the anatomical structure of the superficial femoral artery [5]. Deep femoral artery profundoplasty (DFAP) can improve collateral branches and increase blood supply, but not restore the anatomical structure of the superficial femoral artery [5] Hybrid operations, such as combined SFAS and DFAP, might make the best of both SFAS and DFAP in patients with LEAD [3]. To date, there have been scarce studies that observe its application in Chinese patients, and there have only been controversial results based on the summary of clinical cases

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Discussion

Conclusion