Endovascular femoropopliteal bypass

[Results of autovenous femoro-distal bypass procedures in the type III peripheral obliterative arterial disease of the extremities in diabetic and nondiabetic patients]

INTRODUCTION

It has been established that infrainguinal occlusive disease, type III peripheral obliterative arterial disease (POAD), is more common in diabetics than in non-diabetics. It is presumeable that after surgical treatment of this arterial segment diabetics develop more complications and higher mortality rate than non-diabetics. The aim of this study was to analyze the results of reconstructive surgical treatment of diabetic and non-diabetic patients with type III PAOD.

MATERIAL AND METHODS

In the period 1999-2003, 118 patients with Type III PAOD underwent surgery at the Vascular Surgery Clinic in Novi Sad. They were divided into two groups: group I included 51 nondiabetic patients, and group II 67 diabetic patients. Subgroups were formed based on the clinical status. Differencies were established in IVa, (46 diabetics and 4 non-diabetics) and IVb stage (11 diabetic and 30 non-diabetic patients).

RESULTS

Statistical data analysis using X2 test showed a stastical difference in complications rates, number of salvaged limbs and finally, in the mortality rates between diabetic and non-diabetic patients.

CONCLUSION

Diabetic patients presented with significantly more trophic lesions (IVa stage). The overall complication rate was significantly higher in diabetics, as well as the amputation rate. Finally, the mortality rate was also significantly higher in diabetics than in nondiabetic patients.

Femoro-popliteal reconstructions: "insitu" versus "reversed" technique: comparative results

Introduction. Infrainguinal arterial reconstruction is a procedure with two main types of autologous venous grafts: reversed-vein bypass grafting, and the in situ bypass grafting. Both techniques have advantages and disadvantages, and the aim of this study was to compare the results of each technique. Material and methods. In the period from 1999 to 2003, 118 patients with infrainguinal arterial occlusive disease (IAOD) undenvent reconstruction surgery at the Vascular and Transplantation Surgery Clinic in Novi Sad. 141 reconstruction procedures were performed using the autologous great saphenous vein. The patients were divided into two groups: group I included 72 patients with "in situ " by?pass grafts and group II included 46 with 55 "reversed" bypass grafts. The postoperative function was evaluated by using a pocket-sized Doppler sonography, and by assessment of the postoperative increase in API in regard to preoperative values. Results. Statistical analysis of the investigated groups of patients and X2 showed that there were no statistically significant differences in postoperative patency, complication rate and number of salvaged limbs. Conclusion. We can conclude that both investigated reconstruction techniques have advantages and minor disadvantages: they are applicable, safe and reliable and each has a specific range of indications. .

Multi Centre Study to Assess the Feasibility of a New Covered Stent and Delivery System in Combination with Remote Superficial Femoral Artery Endarterectomy (RSFAE)

OBJECTIVES

To evaluate the feasibility and efficacy of an innovative new covered stent and adjustable deployment system (aSpire Covered Stent, Vascular Architects Inc., San Jose, CA, USA) in combination with remote superficial femoral artery endarterectomy (RSFAE) for the treatment of long segment femoropopliteal occlusive disease.

DESIGN

Prospective multi-centre trial.

MATERIALS AND METHODS

Sixty-two limbs in 61 patients (41 men; median age 69 years, range 40-88) with severe disabling claudication (n=56) or critical limb ischaemia (n=6) were treated in five European centres with aSpire stenting after RSFAE for long segment occlusions (mean length 25 cm). Follow-up was by duplex scanning at 1-, 6-, 12- and 18-months. Primary, primary-assisted and secondary patency rates were analysed.

RESULTS

The median follow-up was 17 (range 2-34) months. A mean of 1.3 stents (range 1-3) were deployed with a median stent diameter of 7 mm (range 6-9). There were one early and 24 late failures. At 18-months the cumulative primary, primary-assisted and secondary patency rates were 60, 70 and 72%, respectively. There were no device related adverse events, such as kinking or fracturing and no stent migrations.

CONCLUSIONS

The aSpire stent and the delivery system are both safe and feasible in combination with RSFAE. The mid term follow-up appears favourable in view of the long segment occlusions treated. Further follow-up is required to compare the mid- and long-term outcomes with current stents and conventional femoropopliteal bypass.

Use of a balloon-expandable, radially reinforced ePTFE endograft after remote SFA endarterectomy: a single-center experience

PURPOSE

To report our experience with endovascular femoropopliteal bypass grafting using a distensible, radially reinforced polytetrafluoroethylene endograft combined with remote endarterectomy.

METHODS

Forty-one patients (33 men; mean age 70 years, range 45-79) with symptomatic femoropopliteal occlusive disease underwent remote endarterectomy of the superficial femoral artery (SFA) followed by implantation of a balloon-expandable Enduring endovascular graft. All patients entered an extensive surveillance program, including angiography and duplex scanning at regular intervals.

RESULTS

Endarterectomy and endograft implantation were ultimately successful in all patients; 5 (12%) technical difficulties occurred intraoperatively and were treated with additional endovascular techniques. Control angiography at 1 week postoperatively demonstrated a patent endograft in 39 (95%) patients. Mean ankle-brachial index increased significantly from 0.57 to 0.91 (p < 0.001). Including the 2 early failures, 18 occlusions were documented over a median 15-month follow-up (range 3-24), due mainly to significant stenosis at the proximal and distal anastomoses. In 8 of 10 successfully reopened and revised endografts, reocclusion occurred after a median interval of only 1.8 months. Life-table analysis revealed cumulative primary and secondary patency rates of 42% and 56%, respectively, at 18 months. In the last 12 cases, the proximal end of the graft was sutured end-to-end to the transected SFA, which improved the short-term secondary patency rate to 83%.

CONCLUSIONS

Insertion of the Enduring endovascular graft following remote endarterectomy effectively results in a less invasive treatment for femoropopliteal occlusive disease. Additional technical refinements of the procedure may be required to avoid early procedure- and graft-related failures.