Recanalization of native superficial femoral artery chronic total occlusion after failed femoropopliteal bypass in patients with critical limb ischemia

Abstract

Objectives This study aimed to examine the outcomes of endovascular recanalization for native superficial femoral artery (SFA) chronic total occlusion (CTO) in patients with critical limb ischemia (CLI) after femoropopliteal bypass failure with limited surgical revascularization options. Background Endovascular recanalization of native artery occlusions has been recently used as a new alternative for threatened limbs after bypass graft occlusion. The feasibility and efficacy has not been widely reported. Methods We retrospectively analyzed 45 consecutive patients (45 limbs) undergoing endovascular recanalization of native SFA occlusion following failed femoropopliteal bypass between June 2010 and December 2016. Results All limbs had Transatlantic Inter‐Society Consensus class C (26.7%, 12/45) or D (73.3%, 33/45) lesions with a mean lesion length of 29.8 cm. The technical success rate was 95.6% (43/45 limbs). The ABI showed a significant increase from 0.3 ± 0.1 pre‐procedure to 0.7 ± 0.1 post‐procedure (P < 0.01). Two early (<30 days) below‐knee amputations due to acute thrombotic ischemia occurred during perioperative period and resulted in one death due to myocardial infarction. The mean follow‐up was 42.7 months (1‐62 months). Two patients were lost to follow up. The primary patency rates at 12 and 36 months were 54% and 51%, respectively. Secondary patency rates at 12 and 36 months were 78% and 61%, respectively. Limb salvage rate was 95% and amputation‐free survival rate was 88% at both 12 and 36 months. Conclusion Recanalization of native SFA CTO due to failed femoropopliteal bypass offers a feasible and safe alternative to surgical reconstruction with acceptable limb salvage.

Endovascular Recanalization of Chronic Total Occlusions of the Native Superficial Femoral Artery After Failed Femoropopliteal Bypass in Patients with Critical Limb Ischemia.

“…Another important nding is that a lesion length ≥ 30 cm and a TASC II D lesion are predictors of primary patency loss. This nding is in contrast with one of the few previously published reports on the endovascular recanalization of the native SFA CTOs in patients with CLI after failed femoropopliteal bypass (Li Z et al, 2018), whose regression analysis had not shown signi cant in uence of a lesion length > 20 cm and a TASC II D lesion on the primary patency loss, but it's in agreement with the historical and contemporary vascular literature on primary endovascular therapy for lower limb lesions (Jørgensen B et al, 1991;Iida O et al, 2014). The below-knee popliteal artery bypass target heralds the presence of a more extensive TASC II D disease of the native SFA, strongly associated with a higher rate of restenosis after a percutaneous intervention ).…”

“…Hence, the idea to recanalize the native SFA chronic total occlusions, in patients with critical limb ischemia (CLI) and femoro-popliteal bypass failure, has been born, limited to those patients un t for surgery or refusing surgical reconstruction. Data regarding this approach in femoro-popliteal bypass failure are limited to few case-series studies (Li Z et al, 2018;Gandini R et al, 2009;Davies MG et al, 2017), so the need of new studies should be emphasized in order to better understand long-term outcomes of this option compared to secondary bypass surgery.…”

Endovascular recanalization of chronic total occlusions of the native superficial femoral artery after failed femoropopliteal bypass in patients with critical limb ischemia

“…Hence, the idea to recanalize the native SFA chronic total occlusions has been born in patients with critical limb ischemia (CLI) and femoro-popliteal bypass failure, limited to those cases unfit for surgery or refusing surgical reconstruction. Data regarding this approach in femoro-popliteal bypass failure are limited to few case-series studies (Li et al 2018 ; Gandini et al 2009 ; Davies et al 2017 ), so the need for new studies should be emphasized to better understand long-term outcomes of this option compared to secondary bypass surgery.…”

Case of successful hybrid revascularization and limb salvage in patient with CLI after multiply ABF thrombosis and absence of outflow arteries

“…Субинтимальная реканализация артерий представляет собой еще одну опцию для эндоваскулярной реваскуляризации конечности [17][18][19][20]. Есть информация о том, что после тромбоза бедренно-подколенно-дистальных шунтов возможно успешное спасение конечности за счет подобных вмешательств [21][22][23][24][25][26]. Тем не менее, насколько нам известно, работ по комбинации этой методики с открытыми вмешательствами пока не было.…”