Early results of surgical and Endovascular intervention procedures in Lower extremity arterial disease

Abstract

Objective : To assess the early results of surgical and endovascular intervention in peripheral arterial disease Materials and methods : Retrospectively, we analysed the early results of treatment of lower extremity arterial diseases, managed at our institute. Depending up on the lesion characters and the distal run-off as evident from imaging, patients underwent either surgical or endovascular intervention for their disease. Over a period of one-year form July 2018 to July 2019, twenty-two patients were managed in total. Nine of them underwent surgical bypass for either aortoiliac or femoro-popliteal lesions. Another thirteen patients underwent endovascular intervention for lesions at aorto-iliac, femoro-popliteal and “Below the Knee” lesions. Procedure related morbidity, procedural success rate, postoperative pain score, hospital stay, flow patency and symptomatic improvement at follow-up at three and six months were analysed. Results: The results were optimistic with ischemic ulcers showing signs of healing, patients symptomatically better with improved walking distance and relieved of rest pain. Due to a smaller study population, limited study time and the study itself being a non- randomised one, no intragroup comparisons were made. The procedural success was 100% for each group, no periprocedural morbidity. The hospital stay was 9 days for surgical aorto bifemoral bypass patients, 5.8 days for femoropopliteal patients. For those who underwent endovascular intervention, average hospital stay was 3.4, 2.5 and 3 days respectively for the aorto-iliac, femoropopliteal and “Below the Knee” level groups. The average pain score was 6.3 and 5.8 for surgical aortobifemoral bypass and femoropopliteal bypass. Pain scores for the endovascular intervention group was 4.4, 3.2 and 4.7 respectively for the aortoiliac, femoropopliteal and “Below the Knee” level groups. The improvement in the Rutherford gradings at six months were Aorto bifemoral Bypass (4.6 to 3.6), Femoro-popliteal (4.1 to 2.6) in the surgical group and Aortiliac (4.4 to 3.4), Femoropopliteal (4.2 to 2) and no change in the score for the “Below the Knee” group. At six-month follow-up, Doppler interrogation revealed a triphasic flow pattern in surgical and endovascular bypasses involving the aortoiliac and femoropopliteal segments. The doppler interrogation for the “Below the Knee” lesions at six-month follow-up was biphasic (n=3) to monophasic (n=1). Conclusion: Surgical bypass and endovascular intervention either as an independent treatment modality or in combination as a Hybrid procedure looks promising in the management of LEAD. Surgical bypass is no doubt morbid, but early results are satisfactory in terms of patency rates and clinical improvement. The early six months results of endovascular intervention, are particularly encouraging in the femoropopliteal segment with poor distal run off. The results are inconsistent for the “Below the Knee” segment disease. TASC II- A and B lesions are addressed by endovascular interventions, whereas TASC II- C and D lesions are addressed by surgical bypass. Multidisciplinary individualised treatment approach should be adopted in deciding which treatment to be provided for a particular patient based on clinical, imaging findings and institutional protocols