Endovascular recanalization of chronic total occlusions of the native superficial femoral artery after failed femoropopliteal bypass in patients with critical limb ischemia

Roberto Minici,Domenico Laganà,Marisa Talarico,Maria Luposella,Salvatore Ciranni,Michele Ammendola,Giuseppe Guzzardi,Marco Minici

doi:10.1186/s42155-021-00256-0

Abstract

BackgroundFemoropopliteal bypass occlusions are a significant issue in patients with critical limb ischemia and chronic total occlusion of the native superficial femoral artery, which challenges vascular surgeons and interventional radiologists. Performing a secondary femoropopliteal bypass is still considered the standard of care, although it is associated with a higher complication rate and lower patency rate in comparison with primary bypass. Over the past few years, angioplasty has been commonly used, with the development in endovascular technologies, to treat chronic total occlusions of the native superficial femoral artery, with a good technical success rate and clinical prognosis. The purpose of the study is to assess the outcome of endovascular recanalization of chronic total occlusions of the native superficial femoral artery, in patients unfit for surgery with critical limb ischemia after failed femoropopliteal bypass.ResultsA total of 54 patients were treated. 77.8 % of the conduits were PTFE grafts; the remainder were single-segment great saphenous veins. The most common clinical presentation was rest pain. Technical success was achieved in 51 (94.4 %) of 54 limbs. Angiographically, 77.8 % of the lesions were TASC II category D, while 22.2 % were TASC II category C. The average length of the native SFA lesions was 26.8 cm. Clinical success, with improved Rutherford classification staging, followed each case of technical success. The median follow-up value was 5.75 years (IQR, 1.5–7). By Kaplan-Meier survival analysis, primary patency rates were 61 % (± 0.07 SE) at 1 year and 46 % (± 0.07 SE) at 5 years. Secondary patency rates were 93 % (± 0.04 SE) at 1 year and 61 % (± 0.07 SE) at 5 years. Limb salvage rates were 94 % (± 0.03 SE) at 1 year and 88 % (± 0.05 SE) at 5 years.ConclusionsThe endovascular recanalization of chronic total occlusions (CTO) of the native superficial femoral artery (SFA) after a failed femoropopliteal bypass is a safe and effective therapeutic option in patients unfit for surgery with critical limb ischemia.

Highlights

Femoropopliteal bypass occlusions are a significant issue in patients with critical limb ischemia and chronic total occlusion of the native superficial femoral artery, which challenges vascular surgeons and interventional radiologists
According to the Trans Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease in nondialyzing patients; (II) (TASC II), surgical revascularization with bypass grafting is the treatment of choice for chronic total occlusions (CTO) of the superficial femoral artery (SFA), with favourable technical success rate and clinical prognosis (Norgren et al 2007)
Performing a secondary femoropopliteal bypass is still considered the standard of care, it is associated with a higher complication rate and lower mid-term patency rate in comparison with primary bypass (Baldwin et al 2004; Belkin et al 1995)

Summary

Introduction

Femoropopliteal bypass occlusions are a significant issue in patients with critical limb ischemia and chronic total occlusion of the native superficial femoral artery, which challenges vascular surgeons and interventional radiologists. Performing a secondary femoropopliteal bypass is still considered the standard of care, it is associated with a higher complication rate and lower patency rate in comparison with primary bypass. The purpose of the study is to assess the outcome of endovascular recanalization of chronic total occlusions of the native superficial femoral artery, in patients unfit for surgery with critical limb ischemia after failed femoropopliteal bypass. Performing a secondary femoropopliteal bypass is still considered the standard of care, it is associated with a higher complication rate (perioperative morbidity of 25 %) and lower mid-term patency rate in comparison with primary bypass (Baldwin et al 2004; Belkin et al 1995). In addition to the above, contraindications to lysis should be considered

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