Can Endarterectomy Be Useful in Peripheral Arterial Occlusive Disease with Critical Limb Ischemia?

Binay Krishna Sarkar,Pares Banerjee

doi:10.4236/wjcs.2019.911018

Abstract

Importance of thrombendarterectomy (TEA) had declined with the advent of bypass techniques and availability of prosthetic grafts, in patients with Peripheral arterial occlusive disease (PAOD). Recently, there had been a significant shift towards lower limb revascularization using endoluminal techniques. However, previously available data evaluating the long leg bypass or combined endoluminal and bypass procedures have been too anatomically heterogeneous to be easily applied to patients with infrainguinal disease and tissue loss. Clinical decision making in Complex multilevel or diffuse peripheral arterial occlusive disease with multiple co-morbidities especially associated coronary arterial disease is challenging. We describe twelve patients of iliofemoral arterial occlusive disease with tibiopopliteal arterial occlusive disease along with multiple co-morbidities like coronary arterial disease and diabetes mellitus who showed marked improvement with minimal post-operative morbidities after iliofemoral or ileopopliteal bypass grafting with endarterectomy of the tibiopopliteal segment and related review of the literature.

Highlights

Complex multilevel or diffuse peripheral arterial occlusive disease is a disabling condition where patients have chronic pain with or without ulceration or gangrene
We describe twelve patients of iliofemoral arterial occlusive disease with tibiopopliteal arterial occlusive disease along with multiple co-morbidities like coronary arterial disease and diabetes mellitus who showed marked improvement with minimal post-operative morbidities after iliofemoral or ileopopliteal bypass grafting with endarterectomy of the tibiopopliteal segment and related review of the literature
With the advent of bypass techniques and availability of prosthetic grafts, there is a marked decline in the number of Surgeons performing this technically demanding procedure [1]

Summary

Introduction

Complex multilevel or diffuse peripheral arterial occlusive disease is a disabling condition where patients have chronic pain with or without ulceration or gangrene. Clinical decision making especially the choice of first-line intervention is often difficult especially in presence of tibiopopliteal disease in presence of mul-. We have several procedures like endarterectomies, bypass grafting and endoluminal procedures often used in combination to address these complex lesions. Thromboendarterectomy (TEA) was the procedure of choice for patients with Peripheral arterial occlusive disease (PAOD) [1] [2]. With the advent of bypass techniques and availability of prosthetic grafts, there is a marked decline in the number of Surgeons performing this technically demanding procedure [1]. There are advantages of autogenously vascular reconstruction and it is useful as an adjunctive procedure

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Conclusion