Heparin-bonded grafts revascularization in patients with critical limb ischemia following endovascular intervention failure

Abstract

Objective To evaluate the efficacy and safety of heparin-bonded graft revascularization in patients with critical limb ischemia (CLI) after failed endovascular intervention. Methods The clinical data of patients who underwent lower extremity bypass after failed endovascular intervention for CLIs from Oct. 2017 to Apr. 2019 were retrospectively analyzed. Individualized surgical therapy including stent removal, endarterectomy, graft or graft combined with autogenous vein bypass and other surgical methods to gain arterial revascularization of the lower extremity was designed based on the patients' symptoms and clinical features. Clinical characteristics, individual surgical therapeutic information, perioperative complications, symptom relief, ulcer wound healing, patency rate and limb salvage rate were analyzed. Results A total of 27 patients were enrolled in this study. Resting pain of 16 cases relieved effectively. Among 11 cases of ulcer and tissue necrosis, 9 cases healed completely and 2 cases of ulcer reduced obviously half a year after operation. Postoperative complications occurred in 6 cases, with no perioperative death occurred. All patients were followed up for (13.0±8.9) months (range: 2-35 months). Kaplan-Meier estimated patency and limb salvage rate. Overall primary patency at 6-, 12- and 24-month was 83.3%, 73.7% and 49.1%, respectively; secondary patency was 91.8%, 82.1% and 70.8%, respectively; limb salvage was 91.8%, 86.9% and 76.6%, respectively. In the subgroup of femoropopliteal bypass, the 1- and 2-year primary patency rate was 86.7% and 49.5%, respectively; secondary patency was 93.3% and 81.7%, respectively; limb salvage was 93.3% and 81.7%, respectively. In the subgroup of femorocrural bypass, the 1- and,2-year primary patency rate was 45.0% and 45.0%, respectively; secondary patency was 58.3% and 58.3%, respectively; limb salvage was 58.3% and 58.3%, respectively. Conclusion In the era of endovascular intervention, traditional arterial bypass can still provide a safe and effective alternative treatment for complex lesions of lower extremity arteries with failed endovascular intervention. It can efectively relive symptoms and improve limb salvage rate. Key words: Critical limb ischemia; Endovascular intervention, failure; Arterial bypass; Heparin-bonded; Graft