LONG-TERM OUTCOMES OF ILIAC ARTERY BYPASS WITH OCCLUSION SUPERFICIAL FEMORAL ARTERY

Highlights

The effect of the occluded superficial femoral artery on the patency of the aorto-femoral baypass remains controversial, since, on the one hand, in the absence of patency of the femoral-popliteal segment arteries, vascular resistance in the proximal segment increases, on the other hand, a passable deep femoral artery is a good runoff.

Background. Aorto-femoral bypass surgery is the “gold standard” in the treatment of extended lesions of the iliac arteries, as well as femoral-popliteal bypass surgery for extended lesions of the SFA, however, open multilevel reconstruction is not always possible (severe comorbid background of the patient, lack of adequate outflow arteries), in this regard, it seems interesting to search for a less invasive method of restoring blood flow by SFA or restoration of blood flow along the DFA of the thigh as along the main collateral of the lower limb.

Aim. To compare the effectiveness of aorto-femoral bypass surgery with restoration of blood flow by DFA and aorto-femoral bypass surgery with extended endarterectomy from SFA

Methods. The study included 82 patients with atherosclerotic lesions of the iliac arteries and arteries of the femoral-popliteal segment. The patients are divided into 2 groups. Group 1 included patients who underwent aorto-femoral bypass surgery with restoration of blood flow through the HBA. The second group consisted of patients who underwent aorto-femoral bypass surgery with loop endarterectomy from PBA. The primary patency of the aorto-femoral shunt, freedom from amputation, freedom from reintervation, as well as long-term survival were evaluated.

Results. Technical success in both groups was 100%. In group 1, there were no cases of early thrombosis of the aorto-femoral shunt and death in the early postoperative period. There are also no cases of amputation. In the second group, 2 cases of thrombosis were registered in the early postoperative period. The 5-year patency of the aorto-femoral shunt was 97.1% in group 1 and 95.7 % in the second group (p = .389) Long–term freedom from amputation did not differ – in group 1 it was 97.1% by year 5 and 93.7% in the second group (p= .098) Long-term survival was higher in the second group, but the difference was not statistically significant (p = .237)

Conclusions. Restoration of blood flow through the deep artery of the thigh with aorto-femoral bypass surgery allows to stop the symptoms of ischemia. Endarterectomy from SFA is an effective and safe alternative to femoral-popliteal bypass surgery. In our research, SFA reocclusion did not lead to acute or critical ischemia, and in half of the cases, the violation of the patency of PBA was asymptomatic. Occluded SFA is not a risk factor for impaired patency of the aorto-femoral shunt in the long term. 

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