Posterior Approach Popliteal Artery Endarterectomy Combined with Above Knee Bypass Versus Below Knee Bypass Surgery for Long Occlusions of the Superficial and Popliteal Arteries: Long-term Results

Abstract

Introduction - Long occlusion of the superficial and popliteal arteries causing limb ischemia often presents a treatment dilemma, especially when autologous vein is absent. Femoropopliteal bypass below-knee position has significant disadvantages: small diameter of popliteal artery doesn’t always corresponds with blood flow from femoral artery due to high peripheral vascular resistance, while collateral arteries surrounding knee joint are excluded from circulation. Therefore, we developed a novel approach to treatment popliteal artery occlusive disease including consecutive endarterectomy using direct posterior approach in prone position and above knee femoropopliteal bypass (E+FemPop bypass) in supine position (Patent RF 2601698). Long-term results of retrospective study will be presented. Methods - The study included 58 patients: 34 underwent E+FemPop bypass (I group), and 24 - distal femoropopliteal bypass (II group). Indications for surgery were claudication in 20, rest pain in 19 and tissue loss in 19. All patients had TASC D lesions affecting superficial femoral artery and P1, P2 or all segments of popliteal artery. At least 1 crural artery was patent from origin to at least 8 cm distally. Results - Primary patency after 74 months of follow-up was 42,05% for E+FemPop bypass and 15,5% for distal bypass (p = 0,0184, log-rank test), and secondary patency was 57,8% and 19,15% (p = 0.00298), respectively. Limb salvage after 74 months was 93,41% after E+FemPop bypass and 44,93% after femoropopliteal bypass below knee surgery (p = 0,0097): 10 amputations in I group (40% major), 9 amputations in II group (100% major). Cumulative primary, secondary patency and limb salvage after 133 months in I group were 37,85%, 52,95% and 30,81% respectively. Conclusion - E+FemPop bypass is a good option for surgical repair in superficial femoral and popliteal arteries occlusions, with better primary and secondary patency rates then distal bypass surgery. If the saphenous vein is not applicable, E+FemPop should be considered.