Outcomes of Popliteal-To-Distal Bypass Combined with Femoropopliteal Artery Endovascular Treatment for Critical Limb Ischemia

Abstract

Objective: The aim of this study was to evaluate outcomes of combined popliteal-to-distal bypass and endovascular treatment (EVT) for femoropopliteal lesions in patients with critical limb ischemia (CLI). Patients and Methods: We reviewed data of 14 CLI patients who were treated by popliteal-to-distal bypass combined with femoropopliteal EVT. The femoropopliteal lesions included 3 TASC II-A, 8 TASC II-B, and 3TASC II-C but no TASC II-D, and balloon dilatation was performed in 9 cases and a stent was placed in 5 cases. The saphenous vein graft was used in all bypasses, and the target arteries were the dorsalis pedis artery in 12 cases and the posterior tibial artery in 2 cases. Results: At 12 and 24 months, primary patency rates were both 79%, primary assisted and secondary patency rates were both 93%, limb salvage rates were both 93%, and survival rates were 92% and 84%, respectively. Restenosis after femoropopliteal EVT occurred in 2 cases, and both were successfully revised by additional endovascular balloon dilatation. Conclusion: Combined popliteal-to-distal bypass and femoropopliteal EVT might be a useful therapeutic option for appropriately selected CLI patients. Intensive follow-up for endovascular treated lesions and vein graft is mandatory.

Endovascular treatment for chronic total occlusion of superficial femoral artery: Is retrograde approach from popliteal artery effective and safe?

“…With regards to a recent study of femoral popliteal bypass in the symptomatic patients with TASC C and D, the 1-year and 5-year primary patency rate following the bypass surgery were 82.1% and 69.4 %, while these rates were lower in EVT as 67.8% and 45.2%, respectively [6] . Referring to the secondary patency, the 1-year and 5-year rates were 93.2% and 79.5% in femoral popliteal bypass surgery group and 90.1% and 85.1% in EVT group, respectively [7] . Despite the lower primary patency rate in EVT group comparing with bypass surgery, EVT had similar rates with bypass surgery in the secondary patency result.…”

Effectiveness of combined superficial femoral artery endovascular therapy with popliteal-to-distal bypass: A paradigm shift in surgical open bypass for chronic limb-threatening ischemia

“…Many investigators have reported combining SFA EVT with popliteal-to-distal bypass; however, only a few recent detailed reports exist. [10][11][12][13] Schanzer et al 10 reported in their series of 23 combined procedures, that the secondary patency of distal bypass graft was 69% at 3 years. Marcucci et al 12 reported in their series of 23 combined procedures that the secondary patency was 82% at 3 years.…”

“…9 A few recent reports of the combined procedure with conventional techniques such as plain old balloon angioplasty (POBA) or self-expandable nitinol stent exist, but these reports do not include SFA EVT with a "contemporary device" such as stent graft, drugcoated balloon, drug-eluting stent, and interwoven nitinol stent. [10][11][12][13] The purpose of this study was to evaluate the results of combining SFA EVT, primarily using a "contemporary device," with distal bypass graft originating from the popliteal artery, and to discuss a paradigm shift in surgical open bypass for CLTI.…”