FEMOROPOPLITEAL BYPASS VS PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY AND STENTING IN TREATMENT OF PERIPHERAL ARTERY DISEASES OF INFRAINQUINAL SEGMENT – SHORT-TERM RESULTS

Abstract

A b s t r a c t: Critical limb ischaemia is a result of occlusive arterial disease in the infrainquinal segment and is a major indication for arterial revascularization, which implies a femoropopliteal bypass procedure or an interventional procedure – stent grafting of the occluded segment. Although indications for both techniques are clearly defined, there are still controversies. Thus, the aim of this study was to determine shortterm results in patients treated with these two treatment modalities. In the period between 2002 and 2008 a total of 70 patients with occlusive arterial diseases of the low extremity were analysed. In 50 out of 70 patients a femoropopliteal bypass was made. Of these, in 30 (60%) patients PTFE material was used and in 20 (40%) patients an autologous saphenous vein graft was used. The other group comprised 20 patients who underwent stenting. In patients treated with surgical revascularization, the major indication for surgery was occlusive arterial disease in: stage II – in 10 patients (20%), stage III – in 5 patients (10%), stage IV – in 25 patients (50%) and the remaining 10 patients (20%) had subacute ischaemia. Arteriography showed three crural patent tributaries in 18% of the patients, two patent crural tributaries in 40% of the patients and one crural patent tributary in 32% of the patients. There were no significant differences concerning indications and arteriographic findings between the two subgroups. The follow-up period lasted for 6 months and the patency rate was 85% (17) for venous bypass, 11 (64.6%) – short-segment lesions (< 4 cm) and 6 (35.3%) longer segment lesions (> 4 cm) versus 76.5% (23) for PTFE graft (p < 0.05), of which 13 (56.5%) were short-segment (<4 cm) and 10 (43.5%) longer segment lesions (> 4 cm). 106 Cvetanovski M. V., Jovev S. et al. Contributions, Sec. Biol. Med. Sci., XXX/1 (2009), 105–118 The following results were obtained for the second group of patients: initially successful stents in 85%; failure in 15% or 2 patients; technical failure in 1 patient or 5%. After 6 months the patency rate was 75% (15), of which 11 patients (73.2%) had short-segment occlusions (< 4 cm) whereas 4 patients (26,8%) had lesions > 4 cm. The baseline value of the lower limb index (ABI – ankle-brachial index) was significantly increased in both groups, from 0.41 to 0.91 in the group with surgical revascularization and from 0.47 to 0.88 in the second group treated with stenting. The same trend was observed after six months. This study demonstrated a small but significant difference (85% vs 75%, p < 0.05) in favour of the autologous saphenous vein, which should be a preferred graft material in all cases for reconstruction of the femoropopliteal segment. When compared to the overall patency rate of PTFE grafts after 6 months there was no significant difference in patency in the group treated with stent grafting (76.5% vs 75%). However, stenting is a method of choice in the treatment of short-segment occlusions – smaller than 4 cm with good early run off (73.2% vs 64.6%, p > 0.05 p = ns). It is obvious that the results are identical to those in treatment with an autologous great saphenous vein, but in comparison with PTFE the results imply stent usage (73.2% vs 56.5%, p < 0.005). Prosthesis (PTFE) is a graft material of choice when the great saphenous vein is used, damaged or calcified and when the occlusion is longer than 4 cm and is not suitable for stent grafting (43.5% vs 26.6%, p < 0.001).