Abstract
Introduction: The Endovascular Correction (EC) has emerged in recent years as a possible alternative to surgical revision (SR) in case of bleeding complications after Peripheral Bypass (PB). The purpose of this study is to evaluate the efficacy and safety of EC compared to SR in case of bleeding complications of PB. Methods: From January 2004 to December 2014, we have undergone surgery 32 patients for acute bleeding in previous PB (25 venous bypass, in situ or reversed, 6 PTFE bypass and 1 composite bypass). The cause of the bleeding was in 14 cases the dehiscence of proximal anastomosis, in 11 cases of distal anastomosis and in 7 cases the rupture of the graft. All patients postoperatively underwent anticoagulation or antiplatelet therapy, antibiotic therapy and close ultrasound follow-up. Patency rate, Limb Salvage rate and Survival rate in the short term were assessed by Kaplan-Meier curves. Results: Of the 32 patients treated for acute bleeding in previous PB, 11 underwent endovascular correction with a technical success of 100% (no need for reintervention), while in 21 patients was performed a surgical revision. Among the latter, in 4 cases (19.1%) an early bleeding occurred, and endovascular correction was promptly performed solving the bleeding in the absence of sequelae (then a total of 15 patients were treated by endovascular correction). The 12-months patency, limb salvage and survival rates were respectively 71.4%, 88.2% and 88.2% in the SR group and 80%, 93.3% and 100% in the EC. Conclusion: This topic underlines that endovascular correction after peripheral bypass bleeding is an attractive alternative to surgery, but there are still few data to change the gold standard treatment. Randomized Clinical Trials comparing the two treatment options are warranted.
Highlights
The Endovascular Correction (EC) has emerged in recent years as a possible alternative to surgical revision (SR) in case of bleeding complications after Peripheral Bypass (PB)
Of the 32 patients treated for acute bleeding in previous PB, 11 underwent endovascular correction (Figures 1 and 2) with a technical success of 100%, while in 21 patients was performed a surgical revision (Figure 3)
In 4 cases (19.1%) an early bleeding occurred, and endovascular correction was promptly performed solving the bleeding in the absence of sequelae
Summary
The Endovascular Correction (EC) has emerged in recent years as a possible alternative to surgical revision (SR) in case of bleeding complications after Peripheral Bypass (PB). Critical Limb Ischemia (CLI) represents the final stage of Peripheral Arterial Disease (PAD), in which the macro-vascular lesions induce such a reduction of the distal perfusion pressure that microcirculation and transport of nutrients are severely altered. 2025% of patients are subjected to primary amputation, 50-60% are subjected to revascularization (surgical and/or endovascular) and 25% are subjected to medical treatment. Atherosclerosis is the main cause of PAD, other risk factors are: smoke, diabetes, hypertension, hypercholesterolemia and hyperhomocysteinemia [5]. Medical treatment of these risk factors is essential both for primary prevention and for recurrence prevention of this disease
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