RESUMEN
BACKGROUND: The purpose of this study was to compare femoropopliteal bypass (FPB) and remote endarterectomy (RE) for long femoropopliteal lesions. METHODS: Single center retrospective propensity matching analysis of the symptomatic patients with long occlusion of the femoro-popliteal segment (>250 mm), who underwent femoro-popliteal bypass above the knee or remote endarterectomy from 2014 to 2020. Primary endpoints: primary patency (PP), secondary patency (SP), target lesion revascularization (TLR). Secondary endpoints: MALE, MACE, clinical improvement and survival. RESULTS: Four hundred patients were divided into two groups: 200 in the FPB group and 200 in the RE group. As a result of propensity score matching, 110 (FPB) and 109 (RE) patients remained. Three-year primary patency rates were 62% for FPB vs. 53% for RE, P=0.16. Secondary patency rates were 84% for FPB vs. 75% for RE, P=0.10. Freedom from TLR were 61% for FPB vs. 71% for RE P=0.21. Survival and amputation-free survival (AFS) also did not differ (93% vs. 94%, P=0.81 and 87% vs. 92%, P=0.19 respectively). Primary patency of the GSV higher than RE (P=0.00) and PTFE (P=0.00). It was established statistically advantages of RE and great saphenous vein (GSV) bypass over a PTFE bypass in SP (P=0.01 P=0.03), TLR (P=0.02 P=0.00) and AFS (P=0.03 P=0.01). CONCLUSIONS: Surgical treatment of long femoropopliteal occlusions with an autovenous bypass or remote endarterectomy showed significantly better results in secondary patency, TLR and AFS than the use of PTFE prostheses. GSV remains the gold standard for femoropopliteal bypass surgery.
Asunto(s)
Endarterectomía , Arteria Femoral , Enfermedad Arterial Periférica , Arteria Poplítea , Puntaje de Propensión , Grado de Desobstrucción Vascular , Humanos , Masculino , Arteria Poplítea/cirugía , Arteria Poplítea/fisiopatología , Arteria Femoral/cirugía , Arteria Femoral/fisiopatología , Estudios Retrospectivos , Femenino , Anciano , Endarterectomía/efectos adversos , Enfermedad Arterial Periférica/cirugía , Enfermedad Arterial Periférica/fisiopatología , Persona de Mediana Edad , Resultado del Tratamiento , Recuperación del Miembro , Factores de Tiempo , Factores de RiesgoRESUMEN
OBJECTIVE: Aim of the study was to improve the immediate and long-term results of stenting of the superficial femoral artery in extended lesions with the changing of the biomechanics of superficial ffemoral artery and of the first portion of the popliteal artery. METHODS: Pilot randomized prospective single-center study were included 70 patients. Patients were randomized into two groups in 1 × 1 format for 35 people using the envelope method. Self-expanding bare metal stents were used in all cases. At the first group standard revascularization procedures with SFA stenting were performed; in the second group, the superficial femoral artery stenting was supplemented with fasciotomy in the Hunter's canal with the superficial femoral artery intersection. The total observation period was 2 years. During the observation period an assessment of the clinical symptoms of the lower extremities, measurement of the ankle-brachial index and ultrasound duplex scanning of the operated segment were performed. RESULTS: All procedures in both groups were successfully performed. Primary patency through 24 months was 28.5% (10 of 35) in group 1 and 60% (21 of 35) in group 2 (p = 0,015). CONCLUSIONS: Changing the biomechanical properties of the distal of the superficial femoral artery segment and of the first portion of the popliteal artery is safe and contributes to the primary patency improvement during the stenting of extended of the superficial femoral artery lesions compared to standard SFA stenting. Dissection of the lamina vastoadductoria with transection of the collateral branches of the knee joint network reduces frequent and severe damages of stents after the stenting of the superficial femoral artery extended lesion. According to the frequency of complications in the early and mid-term postoperative period, limb salvage, mortality and the secondary patency rates, the new method is comparable with standard of the superficial femoral artery stenting.