Revascularization of the deep femoral artery and its inflow vessels to treat critical limb ischemia in patients with thromboangiitis obliterans:a report of 9 cases

Abstract

Objective: To examine the effectiveness of revascularization of the deep femoral artery and its inflow vessels to treat critical limb ischemia in patients with thromboangiitis obliterans (TAO). Methods: The clinical data of 9 TAO patients with critical limb ischemia who underwent deep femoral artery and its inflow revascularization from January 2018 to October 2020 at Department of Vascular Surgery, the First Medical Center, People's Liberation Army General Hospital were retrospectively analyzed.There were all males, aged from 26 to 50 years with onset time from 1 to 7 years.All patients had severe rest pain, and 4 had ischemic ulcers or gangrene.All patients had occlusion of the deep femoral artery origins and(or) its inflow tracts, including 2 ipsilateral common iliac artery occlusion, 4 ipsilateral external iliac artery occlusion, 7 common femoral artery occlusion, and 8 deep femoral artery origins, without the involvement of the contralateral common femoral artery or its inflow tracts.Surgical procedures included femoral endarterectomy with thrombectomy, merge suture, and bypass.Technical success rate, rest pain relief, ulcer healing, patency, amputation rate, and long-term prognosis were recorded. Results: The overall technical success rate was 9/9, including 8 femoral endarterectomies with thrombectomy (with 4 patch-angioplasty with the great saphenous vein, 1 merge suture, and 3 simple sutures), 4 femoral-femoral bypasses with artificial vessels, and 1 superficial femoral artery bypass with the great saphenous vein.Rest pain disappeared after the operation immediately.The follow-up time was 10 to 44 months.All patients survived.The semi-annual patency rate was 9/9, and the one-year patency rate was 6/8.Except for one patient with significantly reduced but unhealed dorsalis ulcer up to now due to continuous heavy tobacco exposure after surgery, all others had no rest pain occurred or recurrence of foot ulcers during the follow-up.Among the 8 patients, 3 cases with recent claudication had continuous moderate tobacco exposure (10 to 20 cigarettes per day or severe passive smoking). Conclusions: For patients with thromboangiitis obliterans involved in the deep femoral artery or its inflow vessels, revascularization should be the primary choice and a good long-term prognosis is promising.Postoperative tobacco exposure (including passive smoking) is of great impact on the prognosis of TAO patients, and smoking cessation education must be reemphasized and reinforced.