The Role of Infrainguinal Bypass Surgery in the Endovascular Era

Abstract

The current worldwide trend in the treatment of peripheral arterial disease (PAD) is towards an increase in endovascular procedures either in the aorto-iliac area or in the infrainguinal district. However, the role of the open repair with a femoro-popliteal bypass is still debated and in our opinion there still a room for traditional surgery in the presence of complex lesions involving the superficial femoral artery and the popliteal and tibial vessels. In this field, vein bypass provides better results than prosthetic grafts, but in selected cases and not only in the absence of a suitable vein, new modified grafts may be used with satisfactory results. The choice between the two options, open and endovascular, that in some cases can be associated in hybrid procedures, depends on several factors. Only if we are able to take into account all the different preoperative issues, we could choose the right procedure in the right patient.

Current trends of major arterial diseases in Korea: based on data from the Health Insurance Review and Assessment Service

“…The role of surgery is still important in the era of ET [ 28 29 ]. Considering the complexities and diversities of vascular treatments, the ability to perform both treatment methods are required to provide better results for patients.…”

Analysis of risk factors for occlusions of a synthetic femoropopliteal bypass graft

“…A significant synergistic effect was found for the combination of type of FP bypass and cardiovascular disease ( adjusted OR 32 We have determined that the angiographic patency of three, two or one crural recipient artery in the group of cases was observed in 11, 14 and 19 patients (25.0%, 31.8%, and 43.2%, respectively), and in the group of controls it was observed in 29, 36 and 23 patients (33.0%, 40.9%, and 26.1%, respectively). In the group of cases there were 11 patients with Dacron and 33 patients with PTFE graft (25% and 75%, respectively).…”

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

“… 5 ) Endovascular therapy (EVT), less invasive than surgery with a low risk of complications, has become the primary method of revascularization for TASC A–C lesions 6 , 7 ) ; bypass surgery still has a place in more complex, multilevel, TASC D lesions. 8 ) Nearly 50% of patients referred for revascularization have a lesion in the superficial femoral artery (SFA). 9 ) Results using percutaneous transluminal angioplasty (PTA) alone to treat SFA lesions are often hampered by vessel recoil and trauma (e.g., dissection), but primary or provisional stent placement can prevent recoil, cover a flow-limiting intimal flap, and restore blood flow.…”