Superficial Femoral Artery Occlusion Research Articles

Comparative Study between Surgical Bypass and Angioplasty in Treatment of Superficial Femoral Artery Occlusion

Comparative Study between Surgical Bypass and Angioplasty in Treatment of Superficial Femoral Artery Occlusion

Femoral Balloon-Oriented Puncture for True Lumen Reentry in the Common Femoral Artery After Subintimal Retrograde Recanalization of Superficial Femoral Artery Ostial Occlusion: The FORLEE Technique

Purpose: To report a new technique to reenter the common femoral artery (CFA) true lumen after retrograde recanalization of a superficial femoral artery (SFA) with flush ostial occlusion. Technique: The technique is demonstrated in a 76-year-old woman with critical limb ischemia previously submitted to several surgical revascularizations. A duplex ultrasound showed flush ostial occlusion of the SFA and patency of the anterior tibial artery at the ankle as the sole outflow vessel. After unsuccessful antegrade attempts to recanalize the SFA, a retrograde guidewire was advanced subintimally up to the CFA, without gaining reentry. A balloon catheter was inflated in the subintimal plane across the SFA ostial occlusion. Antegrade access to the distal CFA was achieved with a 20-G needle, which was used to puncture the balloon. A guidewire was advanced into the balloon and pushed forward while the collapsed balloon was pulled back to the mid SFA. The antegrade guidewire was externalized through a retrograde catheter, which was pushed in the CFA true lumen. A retrograde guidewire was advanced and externalized through the femoral sheath, establishing a flossing wire. The procedure was completed in antegrade fashion. Conclusion: The FORLEE technique is a cost-effective option to gain the CFA true lumen after subintimal retrograde recanalization of an ostial SFA occlusion.

External Iliac Artery to Tibial Arteries Vein Graft for Inaccessible Femoral Artery

An endovascular-first approach to limb salvage and relief from lifestyle-limiting claudication is widely accepted. Stenosis or short occlusion of common, superficial femoral, and popliteal arteries can be corrected with percutaneous transluminal angioplasty (PTA) with stent positioning. Patency rates of these procedures are limited. We report our experience with external iliac artery to the infrapopliteal vessels vein grafts when the endovascular treatment fails. Between January 2013 and January 2019, 16 patients (16 limbs) were operated on for limb-threatening ischemia after the occlusion of PTA with stent positioning of the common, superficial femoral, and popliteal arteries. Three patients were treated at our hospital by interventional radiologists; the remaining were operated on elsewhere. An external iliac artery to the infrapopliteal vessels vein bypass graft was anatomically interposed to restore blood flow. End points of the study were death-related events, vein graft failure, and major (above- or below-knee amputation) or minor (foot or toe amputation) limb loss. There were 12 men and 4 women. Mean age of patients was 68years. Indication for the initial PTA with stent positioning of the common and superficial femoral artery was according to the Rutherford classification Grade I: Category 1, 11 patients (69%) and Category 2, 5 (31%) patients (Stage IIa and IIb according to Fontaine classification, respectively). Great saphenous vein was used in 14 (87%) cases and in 2 (13%) cases a composite graft with a segment of cephalic vein was required. The distal anastomoses were performed on the posterior tibial artery in 6 (37%) cases, anterior tibial artery in 4 (26%), and peroneal artery in 6 (37%). Four-year survival and primary patency rates were 71% (standard error [SE]=0.15) and 73% (SE=0.14), respectively. One graft occlusion required an above-knee amputation. Four-year limb salvage rate was 86% (SE=0.13). We recommend the external iliac artery as source of inflow in patients in whom the vein bypass cannot originate from the common femoral or from a more distal inflow source because of previous PTA with stent positioning or it is deemed hazardous.

Influence of Tyrosine Kinase Inhibitor, Nilotinib, on Delayed Healing of Bare-Metal Stents in Superficial Femoral Arteries: Insights From Angioscopic Findings

A 72-year-old individual with hypertension and 5-year history of chronic myeloid leukemia under therapy with tyrosine kinase inhibitor nilotinib was referred to us with intermittent claudication due to chronic total occlusion of bilateral superficial femoral arteries (SFA). He had undergone

Role of Retrograde Transpopliteal Angioplasty for Superficial Femoral Artery Occlusion

Background: surgical interventions are indicated for patients with peripheral arterial disease (PAD) who developed CLI or debilitating IC that is refractory to conservative management; while bypass, with an autologous vein or prosthetic conduit, is the mainstay of open surgical management of PAD. On the other hand, the percutaneous endovascular interventions has emerged as an alternative effective, and safe, treatment option in patients with PAD. Objective: the aim of the study was to evaluate the effectiveness and safety of the retrograde popliteal approach for recanalization of long segment occlusion of superficial femoral artery in cases with chronic lower limb ischemia. Patients and Methods: this is a prospective study conducted on 30 patients presenting to Al-Azhar University Hospitals and Mataria Teaching Hospital; all of them have chronic lower limb ischemia due to proximal long segment occlusion of superficial femoral artery (SFA) after failure to pass through the antegrade access either by the ipsilateral or by the contralateral femoral approach. Results: ankle brachial index (ABI) is a commonly used surrogate marker of atherosclerosis. In the present study, the rate of complications was relatively low (16.7%) in which pseudoaneurysms were encountered in 10% and arteriovenous fistulae were encountered in 6.7% of the patients. Conclusion: retrograde popliteal approach is feasible, safe, and effective technique for the management of CTO of superficial femoral artery in patients with failure of pass through the antegrade access either by the ipsilateral or by the contralateral femoral approach.

TCTAP C-171 Endovascular Treatment for Chronic Total Occlusion of Superficial Femoral Artery After Axillofemoral Bypass

### Patient Initials or Identifier Number K.S ### Relevant Clinical History and Physical Exam A 74-year-old male patient was admitted with intermittent claudication of the left leg for several months. The pulsation of left dorsalis pedis could not be palpable. He underwent the axillofemoral

Drug-eluting balloon angioplasty versus bare-metal stent in treating chronic total occlusion of femoropopliteal arterial segment: a review of 1-year outcome of 90 patients with TASC C and D lesions

Background Bare-metal stent (BMS) scaffolding of superficial femoral artery occlusive lesions has been associated with high rates of late clinical failure. Maintaining the patency of recanalized arterial segments was the main issue behind the concept of leaving nothing behind to be evolved and percutaneous balloon angioplasty becomes the preferred option for endovascular therapy. Drug-eluting balloons (DEBs) have shown to be an effective alternative to BMS for patients with de novo complex superficial femoral occlusive disease. Aims The aim was to compare the outcome of DEB versus BMS in treating complex chronic total occlusion of superficial femoral and proximal popliteal artery in patients with disabling claudication and critical limb ischemia regarding technical success, primary patency, clinically driven target lesion revascularization (cd-TLR), and limb salvage rate. Materials and methods The current study is a multicenter, prospective, randomized study. Ninety patients (110 limbs) complaining of disabling and critical limb ischemia due to complex femoropopliteal occlusive lesions were randomly allocated into two groups according to the intervention method performed. Group A included 48 patients (57 limbs) who were submitted for treatment with paclitaxel DEBs and group B included 42 patients (53 limbs) submitted for treatment with BMS. The follow-up period was for 1, 6, and 12 months. Statistical analysis was performed by using the IBM SPSS Statistics version 22 for Windows Program Package (SPSS Inc., Chicago, IL, USA). Results BMSs seem to have lower patency and higher cd-TLR rates compared with patients who received paclitaxel drug-coated balloons but was not statistically significant. The primary patency rates were 100, 96, and 86.2% at 1, 6, and 12 months’ respectively’ in the DEB group versus 100, 89.8, and 77.6% at 1, 6, and 12 months, respectively, in the BMS group. Clinically driven TLR rates were 2 and 7.8% at 6 and 12 months, respectively, in the DEB group versus 6.1 and 14.2% at 6 and 12 months, respectively, in the BMS group. Conclusion Percutaneous therapy for Trans atlantic inter-societies consensus (TASC) C and D femoropopliteal lesion using DEB or BMS is safe and effective with a high patency rate of 1 year. Paclitaxel drug-eluting balloons seem to have a promising role in the prevention of restenosis and recurrence of peripheral arterial occlusive disease. However, stents are still playing important bailout role in the treatment of residual stenosis and dissection. Further follow-up is essential to obtain and document long-term outcome of different percutaneous therapy for complex and long superficial femoral artery (SFA) lesions.

TCTAP C-188 Double Layer Stents Technique to Conquer the Severe Recoil Phenomenon After Recanalization of Severe Calcified Chronic Total Occlusion of Left Superficial Femoral Artery

TCTAP C-188 Double Layer Stents Technique to Conquer the Severe Recoil Phenomenon After Recanalization of Severe Calcified Chronic Total Occlusion of Left Superficial Femoral Artery

Role of Retrograde Transpopliteal Angioplasty for Superficial Femoral Artery Occlusion

Role of Retrograde Transpopliteal Angioplasty for Superficial Femoral Artery Occlusion

Combined Direct Endarterectomy and Fogarty Thrombectomy with Endovascular Therapy for Subacute Occlusion of the Superficial Femoral Artery.

A 78-year-old woman with a prior history of a right femoropopliteal bypass 5 years before and a coronary artery bypass graft 3 months before was admitted for a non-healing ulcer on her right foot. A computed tomography angiogram revealed occlusion of her superficial femoral artery (SFA) from its orifice to the anastomotic site of the bypass graft. The lesion was thought to consist of a partial atherosclerotic plaque with a large number of relatively fresh thrombi, referring to an angiogram of her lower extremity 3 months ago. We recanalized the occlusive SFA by Fogarty thrombectomy, and endovascular therapy preceded by direct SFA endarterectomy.

Superficial Femoral Artery Occlusion Reduces Aortofemoral Bypass Graft Patency

The effect of superficial femoral artery (SFA) occlusion on long-term patency of aortofemoral bypasses (AFBs) for aortoiliac occlusive disease (AIOD) was examined. The AIOD database was reviewed to identify risk factors for AFB failure. The status of the SFA at AFB procedure was categorised as patent; diseased treated (DT), if the SFA occlusion was intervened on concomitant to AFB; or diseased untreated (DU), if the SFA was occluded but not revascularised. Censoring hierarchies for primary patency and patent graft survival time were constructed. Data were analysed by contingency table, Kaplan-Meier, and Cox regression analysis. Between 2004 and 2015, 122 AFB (9 unifemoral, 113 bifemoral) for AIOD were performed. Seventy-five (61%) were female and the mean age was 60±10 years. At the time of AFB, 50 (41%) had occluded SFAs (DT/DU). Of these, 15 had concomitant SFA revascularisation (i.e., DT) at the time of AFB. Patients with occluded SFAs had greater history of prior aortoiliac/infrainguinal procedures (aortoiliac 54% vs. 22%, infrainguinal 58% vs. 25%, both p<0.001), Trans-Atlantic Inter-Society Consensus II classification of femoropopliteal type D lesions (78 vs. 10%, p<0.001), Rutherford 4-6 categories (80% vs. 57%, p=0.011), and longer hospital stay (median 11 vs. 7 days, p<0.004). SFA status did not affect 30 day mortality (overall 9%); however, sub-analysis showed DT had significantly higher mortality than DU (p<0.03). Over a median follow up of 7.7 (IQR 4.3-11.4) years, primary patency at one and five years was 98.3% and 91.2% in patients with patent SFAs, 87.9% and 82.7% in DU, and 72.7% and 43.6% in DT (p<0.001), respectively. On multivariable analysis, low baseline glomerular filtration rate (HR 1.01, p=0.022), DT (HR 3.7, p=0.020), Rutherford 4-6 (HR 9.1, p=0.048), and occluded SFA (HR 3.9, p=0.009) adversely affected primary patency of AFBs. Long-term mortality was not different between the SFA status groups (p=0.279). Baseline SFA occlusion predicted a fourfold increased hazard of primary AFB failure. Concomitant SFA revascularisation did not improve AFB durability and was associated with increased in hospital mortality.

Sealed Rupture of the Superficial Femoral Artery After Endovascular Treatment Via the Controlled Antegrade and Retrograde Subintimal Tracking Technique for Chronic Total Occlusion

A 73-year-old man presented with intermittent claudication of the right lower limb. His angiogram showed a long-segment chronic total occlusion (CTO) in the right superficial femoral artery (SFA) ([Figure 1A][1]). A 6-F guiding sheath was inserted into the right common femoral artery via the

Endovascular treatment of TransAtlantic Inter-Society Consensus II D femoropopliteal lesions in patients with critical limb ischemia

ObjectiveThe outcomes of endovascular treatment of femoropopliteal atherosclerotic lesions have been improving recently. Although open repair is indicated for class D femoropopliteal lesions based on the TransAtlantic Inter-Society Consensus II (TASC II) document, in some cases, it is reasonable to use the endovascular approach for these lesions. The aim of this study was to retrospectively analyze the technical aspects and outcomes of treating TASC II D femoropopliteal disease with endovascular approaches. MethodsIn total, 91 procedures between January 2011 and December 2016 were retrospectively analyzed. We collected data corresponding to the technical aspects and outcomes of treatment from an electronic database. Images and videos of all procedures were reviewed. Among the 91 procedures, 70 were for popliteal artery occlusions involving the trifurcation vessels, and 12 were for superficial femoral artery (SFA) occlusions of >20 cm in length; 9 procedures for occlusions meeting both criteria were also performed. The χ2 test was employed for statistical analyses, and logistic regression analyses were conducted to identify risk factors. Patency, wound healing, and survival were analyzed using the Kaplan-Meier method. Statistical significance was considered at P < .05. ResultsApproximately 44.4% of all patients were male. The mean age was 67.3 ± 20.7 years. Hypertension, diabetes, current smoker, kidney impairment, coronary disease, and cardiac insufficiency were identified in 92.3%, 66.6%, 21.7%, 7.6%, 25.6%, and 62.8% of the patients, respectively. All included patients had critical limb ischemia (11.5%, 84.6%, and 3.8% of cases corresponding to Rutherford categories 4, 5, and 6, respectively). Technical failure was observed in three patients (3.3%). The mean number of stents used was 0.7 ± 0.65 per patient. Primary patency at 30 days, 1 year, 2 years, and 3 years was 91%, 60.1%, 55.7%, and 50.6%, respectively. Limb salvage at 30 days, 1 year, 2 years, 3 years, and 4 years was 95.2%, 82.2%, 76.9%, 71.8%, and 63.7%, respectively. Reinterventions were necessary in 11.1% of the patients. Comparison of curves revealed significant differences in the 60-day primary patency for the SFA and popliteal groups (standard error, <10%; log-rank, P = .039). Analysis of the risk and technical factors affecting primary patency, limb salvage, and overall survival indicated that female sex was associated with poor survival (odds ratio, 8.942; 95% confidence interval, 1.105-72.36) and that the use of stents was associated with high rates of limb loss in the popliteal group (log-rank, P = .033). ConclusionsFor endovascular treatment of TASC II D femoropopliteal lesions, primary patency was better in patients with popliteal artery occlusions involving the trifurcation vessels than in those with SFA occlusions >20 cm in length. Female sex was associated with the risk of major amputations, and the use of stents in patients with popliteal occlusions was associated with major limb loss.

Early and mid-term results of surgical and endovascular intervention in total occlusion of superficial femoral artery: Which one is better?

Objectives: Lower extremity peripheral artery disease is a common and important type of systemic atherosclerosis. The purpose of this study is to compare safety and effectiveness of balloon angioplasty, primary stenting and femoropopliteal bypass to treat total superficial femoral artery (SFA) lesions. Methods: 181 consecutive limbs from 149 patients who underwent endovascularly or surgically infrainguinal interventions between June 2013 and June 2017 were included in this retrospective study. Seventy-four legs (40.2%) underwent femoropopliteal bypass surgery, 58 legs (31.5%) were treated with balloon angioplasty, and nitinol stents were used in 49 (23.9%) legs. Results: A total of 149 patients were treated; surgically 56 patients and endovascularly 45 + 40 patients. The mean follow-up time was 24 months (range 4–56 months). The patency rates were 86.7% in the angioplasty group, 82.5% in the stent group, and 94.6% in the bypass group at the end of 24 months (P = 0.159). The rate of reintervention was three patients in the bypass group, six patients in the angioplasty group, and seven patients in the stent group (P = 0.159). The mean reintervention time in bypass was 52.075 months, 43.467 months in balloon angioplasty, and 44.075 months in stent group. Conclusions: There was no significant difference between groups in terms of reintervention and patency rates.

Role of Retrograde Trans-Popliteal Access for Surgical High-Risk Patients with TASC II-D Femoro-Popliteal Occlusive Disease: A Single Center Experience

Objectives: To compare the safety and efficacy of retrograde trans-popliteal access in total Superficial Femoral Artery (SFA) occlusions (TASK II-D) in surgical high-risk patients, in the presence of a patent popliteal artery, after unsuccessful antegrade lesion crossing attempts. Patients and methods: This is a retrospective study including 58 surgical high-risk patients with TASC II D femoro-popliteal occlusive diseases. After failure of antegrade access to cross the occlusion in 9 patients, medial retrograde trans-popliteal access was successfully achieved, followed by snaring of the retrograde wire through rendezvous technique. Perioperative complications and technical success were compared between different access groups. Results: 58 patients were included in the study; 15 men (25.9%) and 43 women (74.1%). 42 patients (72.4%) underwent contralateral retrograde access at Common Femoral Artery (CFA), 7 patients (12.1 %) ipsilateral antegrade access at CFA, 9 patients (15.5%) ipsilateral retrograde access at popliteal artery. All patients were ASA grade 4. Technical success was highest with contralateral retrograde entailing 40 cases (95.2%), followed by ipsilateral ante-grade access (6 cases - 85.7%) and lowest with ipsilateral retrograde (7 cases-77.8%). Conclusion: Transpopliteal retrograde approach can be utilized safely and efficiently using a medial infracondylar retrograde popliteal puncture, with the patient in the supine position. Furthermore, this retrograde popliteal approach can be considered a valid alternative for SFA or proximal PA recanalization after a failed antegrade approach, especially in high risk surgical patients (ASA 4).

Five-year outcomes after revascularization of superficial femoral artery occlusion using Ocelot catheter.

IntroductionThe population of patients with lower limb atherosclerosis includes a considerable proportion of individuals with long superficial femoral artery (SFA) lesions. Chronic total occlusions (CTOs) represent the “last frontier” of percutaneous interventions. While open strategies are considered earlier as standard management for these lesions, the results of a number of trials indicate that endovascular management might become an effective alternative to surgery.Material and methodsThis paper presents 5-year outcomes of a first-in-man (FIM) study (before CE mark) and the registry of OCT Guided Ocelot Catheter (Avinger) for chronic total occlusions of the superficial femoral artery. The study group comprised 10 patients with Rutherford 3 lower limb ischemia including nine men and one woman.ResultsThe efficacy of the primary intervention was 90%. Angiography performed at 6 months of the procedure, according to the study protocol, revealed 3 and 1 cases of restenosis and reocclusion, respectively, repaired using PTA and open common and deep femoral artery patch plasty. Doppler ultrasound performed at 1, 2 and 5 years after the primary intervention did not reveal significant target vessel restenosis. The primary and primary-assisted patency was 89%. During a 5-year follow-up, four peripheral percutaneous interventions and one femoropopliteal bypass surgery were performed in non-target limbs. There were no cardiovascular deaths, myocardial infarction or stroke and no amputation was required.ConclusionsThis is a first-in-man study reporting long-term follow-up after SFA CTO revascularization using the Ocelot catheter. The catheter proved to have a satisfactory safety profile and a high proportion of CTO crossings. A 5-year follow-up revealed high primary and primary-assisted patency rates.

Acute Limb Ischemia as Presentation of Occult Hepatocellular Carcinoma

It is well known that patients with malignancy are at higher risk for venous thrombosis. However, the risk of arterial thrombosis is not well established and more recently it is being recognized as a serious complication of cancer. A 62 year old male with history of prior cocaine abuse and 25 pack year tobacco use who presented with acute worsening left leg pain associated with distal numbness and tingling up to the left knee. Vitals were unremarkable and physical exam was notable for cool left lower extremity below knee and non—palpable pulses without motor or sensory deficits. CT angiogram of lower extremities showed occlusion of left common, external iliac and superficial femoral arteries for which patient was taken urgently for left leg open thrombectomy and angioplasty with stent placement. Lower extremity CT angiogram showed the incidental findings of a large hypervascular liver mass measuring 9 x 8 x 7cm with several small hypervascular nodules and a 1.2 cm hypervascular focus in the gallbladder. MRI of the abdomen—pelvis showed 10 x 10 cm heterogeneous hypervascular hepatic mass compatible with hepatocellular carcinoma (HCC) with mass effect on the right hepatic vein. Laboratory tests revealed positive hepatitis C (HCV) antibody, HCV viral load of 32,865 and genotype 1A. Hepatitis B serology and alpha—fetoprotein were normal. Further chart review revealed that the patient was diagnosed with HCV in 2009 at an outside hospital and had not received confirmatory testing or treatment as the patient refused. He underwent transarterial chemoembolization and subsequent right hepatectomy with multiple in—hospital complications including acute cholecystitis, spontaneous bacterial peritonitis requiring a prolonged antibiotic course. Traditionally, cancer has been associated with increased risk of venous thromboembolism given alteration in clotting factors. However, cancer is not a well—established independent risk factor for arterial thromboembolism and patients with malignancy do not routinely receive therapies to prevent complications such as MI and stroke. Few cases of spontaneous arterial thrombosis with no iatrogenic or atherosclerotic cause in cancer patients have been reported in literature and are associated with poor prognosis. More studies need to be conducted to determine whether patients would benefit from anti—platelet or anti—coagulation in prevention of arterial thrombosis in order to improve long—term survival outcomes.

Nitinol Self-Expanding Stents for the Treatment of Obstructive Superficial Femoral Artery Disease: Three-Year Results of the RELIABLE Japanese Multicenter Study.

Objective: To assess the use of a nitinol stent to treat symptomatic stenoses or occlusions of the native superficial femoral artery (SFA).Materials and Methods: Seventy-four patients were treated at 12 Japanese sites. The primary endpoint, freedom from target-limb failure (TLF), was a composite of device- or procedure-related death, target-limb amputation, target-vessel revascularization (TVR), or restenosis compared to an objective performance goal (OPG) at 12 months. Secondary endpoints, including primary patency, freedom from TVR/target-lesion revascularization (TLR), improvements in clinical parameters, and major adverse events (MAEs) were evaluated through 36 months.Results: The mean overall lesion length was 80.7±38.9 mm (mean stented length: 98.8±46.1 mm). Freedom from TLF was 81.2% (p<0.001 compared to OPG) with a Kaplan–Meier estimate of 84.2% [95% confidence interval (95%CI) 73.3%, 90.9%] at 12 months. Primary patency was 71.0% at 12 months and 67.8% at 36 months. A total of 94.7% of patients improved by at least one Rutherford category and 70.2% of patients improved ankle–brachial indices ≧0.10 from baseline to 36 months. Freedom from TVR/TLR (Kaplan–Meier) was 90% at 12 months and 79.5% at 36 months. Four MAEs were reported; none were found to be device or procedure related.Conclusion: A self-expanding stent was used safely to treat stenotic and occlusive lesions of the SFA in a Japanese patient population. The composite endpoint, freedom from TLF, was superior to an historical control at one year, with low rates of revascularization and good functional and clinical outcomes through three years.

Surgical treatment of stenotic–occlusive affections of the lower extremity arteries in patients, suffering ischemic form of the diabetic foot syndrome

Objective. To compare the efficacy of different methods of surgical treatment for stenotic-occlusive affection of the lower extremities (LE) arteries in patients with ischemic form (ІF) of diabetic foot syndrome (DFS).&#x0D; Маterials and methods. Results of surgical treatment were analyzed in 164 patients, suffering diabetes mellitus Type II, complicated by IF of DFS with critical ischemia on background of combined stenotic-occlusive affection of the femoral and popliteo-tibial segments arteries.&#x0D; Results. Primary passability of the femoral reconstruction zone was registerd in 65.6% of patients, in whom reconstruction of femoral arterial segment was performed without intervention on arteries of popliteo-tibial segment, and the secondary one – in 81.9%, high amputations rate have constituted 18% and lethality – 11.5%. Primary passability of the femoral reconstruction zone was registered in 89.5% patients, to whom a two-level reconstruction of femoral and popliteo-tibial arterial segments was performed, and a secondary one – in 92.1%, high amputations rate have constituted 5.2% and lethality – 7.9%.&#x0D; Primary passability of the femoral reconstruction zone was registered in 81.5% patients, to whom hybrid arterial reconstruction was performed, and a secondary one – in 93.9%, high amputations rate have constituted 7.7% and lethality – 4.6%.&#x0D; Conclusion&#x0D; &#x0D; While coexistence of the superficial femoral artery (SFA) occlusion with stenotic-occlusive affection of the popliteo-tibial segment arteries in patients, suffering stenotic-occlusive affection of arteries in popliteo-tibial segment in cases with IF of DFS the results of performance of isolated operation for the SFA restoration were the worst.&#x0D; The results of a two-level and a hybrid operations may be considered comparable. Primary passability of the arterial reconstruction zone in patients, to whom a two-level reconstruction was performed, is highest, but lethality almost twice as bigger, than after hybrid arterial reconstruction.&#x0D; Hybrid reconstructive operation constitutes optimal procedure in patients, suffering lower extremities (LE) arteries affection in cases with the ІF of DFS, combined with stenotic-occlusive affection of arteries in femoral and popliteo-tibial segments.&#x0D;

Long-Term Results of Crossover Bypass for Iliac Atherosclerotic Lesions in the Era of Endovascular Treatment: The Re-ACTION Study (Retrospective Assessment of Crossover Bypass as a Treatment for Iliac LesiONs).

Objective: The aim of this study was to elucidate the long-term results of crossover bypass (CB) for iliac atherosclerotic lesions in the era of endovascular treatment (EVT).Methods: A retrospective multicenter cohort study was performed. CB was performed in 242 patients between 2003 and 2014 by vascular surgeons at multiple medical centers in Japan.Results: Perioperative mortality was 1.7%. Primary patency rates were 86% at 5 years and 82% at 8 years. Univariate analysis showed that critical limb ischemia (Rutherford class 4–6), vein graft, and superficial femoral artery occlusion were significantly associated with low primary patency. In multivariate analysis, only critical limb ischemia influenced primary patency. The secondary patency rate was 87% at both 5 and 8 years. The limb salvage rate was 98% at both 5 and 8 years. The overall survival rates were 71% at 5 years and 49% at 8 years.Conclusion: The long-term results of CB were good in our study, compared with previous reports. Our results suggest that CB remains an option for the arterial reconstruction in unilateral iliac occlusive disease after EVT failed.