Superficial femoral artery percutaneous intervention is an effective strategy to optimize inflow for distal origin bypass grafts

Abstract

Iliac angioplasty in preparation for an infrainguinal bypass graft has been shown to be an effective strategy. We undertook this study to determine if superficial femoral artery (SFA) angioplasty offers durable inflow for distal origin grafts originating from the SFA or popliteal artery. All distal origin grafts performed at a single institution between 1988 and 2006, </=30 days of an ipsilateral SFA percutaneous intervention, were reviewed retrospectively. Patients were identified from a computerized vascular registry, and data were obtained by review of patient charts, angiograms, and duplex studies. We identified 23 autogenous distal origin grafts procedures performed distal to an SFA intervention, of which 22 were performed for critical limb ischemia (96%). The SFA lesions intervened on (20 angioplasty alone, 3 angioplasty with stenting) included 11 TransAtlantic Inter-Society Consensus (TASC) A (48%), seven TASC B (30%), five TASC C (22%), and no TASC D (0%). Of the bypasses, five originated from the distal SFA, five originated from the above knee popliteal artery, and 13 originated from the below knee popliteal artery. A significant majority of the patients (87%) were diabetic. No deaths, amputations, or early graft failures occurred during the perioperative period. The mean duration of follow-up was 40.8 months. By life-table analysis, the primary patency rate was 58% at 5 years. The primary assisted patency rate was 69% at 5 years. Of the seven interventions required to maintain patency, only one targeted the SFA. None of the graft failures could be specifically attributed to disease progression of the SFA. The 5-year limb salvage rate was 70% and the survival rate was 65%. Percutaneous SFA intervention in preparation for a distal origin graft is a useful and effective strategy in select patients. The durability appears comparable with distal origin grafts performed in the absence of an SFA intervention. This strategy provides a good option in the setting of both atherosclerotic SFA disease and limited autogenous conduit.