Results of femoral-popliteal bypass above knee with synthetic graft
Abstract
To date, with
occlusions of the superficial femoral artery having a long length, the method
of choice is femoral-popliteal bypass surgery. In the absence of an autovenous
shunt, synthetic prostheses made of polytetrafluoroethylene (PTFE) are the most
commonly used for bypass surgery. Accordingly, the aim of the study was
to evaluate the results of femoral-popliteal bypass surgery performed for the
first time using synthetic prostheses above the knee joint gap in patients with
chronic lower limb ischemia.
Material and
methods. A retrospective cohort study was conducted on the
basis of the Sverdlovsk Regional Clinical Hospital No. 1 in Yekaterinburg,
which included 92 patients who underwent reconstructive surgery in the vascular
surgical department from 2016 to 2020 for chronic atherosclerotic occlusion of
the superficial femoral artery. All patients underwent surgical treatment –
femoral-popliteal bypass surgery with a synthetic prosthesis made of PTFE above
the knee joint gap.
Results. In the immediate postoperative period, a significant increase in the
ankle-shoulder index was noted. 24 months after the surgical treatment, the
primary patency of the femoral-popliteal shunt was 55.4%. In the postoperative
period, about 10% of limb amputations were performed at the level of the upper
third of the thigh at different follow-up periods.
Conclusion. Performing femoral-popliteal bypass surgery above the knee joint gap
using synthetic PTFE prostheses of 7 and 8 mm in size demonstrated high
efficiency, a small number of postoperative complications, satisfactory primary
patency of shunts 2 years after surgery, as well as a sufficiently high freedom
from amputation.
Keywords:peripheral artery diseases; atherosclerosis; femoral-popliteal bypass surgery; synthetic prosthesis; polytetrafluoroethylene (PTFE)
Funding. The study had no sponsor support.
Conflict of
interest. The authors declare no conflict of interest.
For citation: Pogosian V.A., Chernyad’ev S.A., Fadin B.V. Results of
femoral-popliteal bypass above knee with synthetic graft. Clinical and
Experimental Surgery. Petrovsky Journal. 2024; 12 (1): 68–73. DOI: https://doi.org/10.33029/2308-1198-2024-12-1-68-73
(in Russian)
References
- Yahagi K., Otsuka F., Sakakura K., Sanchez O.D., Kutys R., Ladich E.R., et al. Pathophysiology of superficial femoral artery in-stent restenosis. J Cardiovasc Surg (Torino). 2014; 55 (3): 307–23.
- Sazhinov A.P., Lukinsky A.V., Chupin A.V. Ways to improve the patency of femoral-popliteal-tibial grafts. Angiologiya i sosudistaya khirurgiya [Angiology and Vascular Surgery]. 2014; 20 (1): 141–5. (in Russian)
- Burkov N.N., Kazantsev A.N., Anufriev A.I., Danilovich A.I., Smirnov K.V., Lider R.Yu, et al. The results of femoral-popliteal reconstruction with a biological prosthesis «KemAngioprosthesis». Kardiologiya i serdechno-sosudistaya khirurgiya [Cardiology and Cardiovascular Surgery]. 2020; 13 (1): 29–35. DOI: https://doi.org/10.17116/kardio20201301129 (in Russian)
- Pokrovsky A.V., Bokeria L.A., Akchurin R.S., Alekyan B.G., Arakelyan V.S., Vachev A.N., et al. National recommendations for the diagnosis and treatment of diseases of the arteries of the lower extremities. Moscow, 2019: 89 p. (in Russian)
- Ambler G.K., Twine C.P. Graft type for femoro-popliteal bypass surgery. Cochrane Database Syst Rev. 2018; 2 (2): CD001487. DOI: https://doi.org/10.1002/14651858.CD001487.pub3
- Klinkert P., Post N.P., Bresiau P.J., van Bockel J.H. Saphenous vein versus PTFE for above-knee femoro-popliteal bypass. A review of literature. Eur J Vasc Endovasc Surg. 2004; 27: 357–62.
- Walluscheck K.P., Bierkandt S., Brandt M., Cremer J. Infrainguinal ePTFE vascular graft with bioactive surface heparin bonding. First clinical results. J Cardiovasc Surg (Torino). 2005; 46: 425–30.
- Xu D., Zou L., Xing Y., Hou L., Wei Y., Zhang J., et al. Diagnostic value of ankle-brachial index in peripheral arterial disease: a meta-analysis. Can J Cardiol. 2013; 29 (4): 492–8. DOI: https://doi.org/10.1016/j.cjca.2012.06.014
- Baker J.D., Dix D.E. Variability of Doppler ankle pressures with arterial occlusive disease: a valuation of ankle index and brachial-ankle pressure gradient. Surgery. 1981; 89: 134–7.
- Aboyans V., Ricco J.B., Bartelink M.E., Björck M., Brodmann M., Cohner T., et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial disease, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018; 55 (3): 305–68.
- Kapfer X., Meichelboeck W., Groegler F.M. Comparison of carbon-impregnated and standard ePTFE prostheses in extra-anatomical anterior tibial artery bypass: a prospective randomized multicenter study. Eur J Vasc Endovasc Surg. 2006; 32 (2): 155–68. DOI: https://doi.org/10.1016/j.ejvs.2005.12.015
- Gulkarov I., Malik R., Yakubov R., Gagne P., Muhs B.E., Rockman C., et al. Early results for below-knee bypasses using Distaflo. Vasc Endovasc Surg. 2008; 42 (6): 561–6. DOI: https://doi.org/10.1177/1538574408322659
- Donker J.M., Ho G.H., Te Slaa A., de Groot H.G., van der Waal J.C., Veen E.J., et al. Midterm results of autologous saphenous vein and ePTFE pre-cuffed bypass surgery in peripheral arterial occlusive disease. Vasc Endovasc Surg. 2011; 45 (7): 598–603. DOI: https://doi.org/10.1177/1538574411414923
- Ruckert R.I., Tsilimparis N., Lobenstein B., Witte J., Seip G., Stork M. Midterm results of a precuffed expanded polytetrafluoroethylene graft for above knee femoropopliteal bypass in a multicenter study. J Vasc Surg. 2009; 49: 1203–9.
- Obara A., Dziekiewicz M.A., Maruszynski M., Witkowski A., Dabrowski M., Chmielak Z. Lymphatic complications after vascular interventions. Wideochir Inne Tech Maloinwazyjne. 2014; 9 (3): 420–6. DOI: https://doi.org/10.5114/wiitm.2014.43021
- Lv S., Wang Q., Zhao W., Han L., Wang Q., Batchu N., et al. A review of the postoperative lymphatic leakage. Oncotarget. 2017; 8 (40): 69 062–75. DOI: https://doi.org/10.18632/oncotarget.17297
- Kashaev M.Sh., Yakupov A.R. Comparative evaluation of the results of surgical treatment of patients with atherosclerotic occlusion of the femoral-popliteal segment in the early post-operative period. Meditsinskiy vestnik Bashkortostana [Medical Bulletin of Bashkortostan]. 2018; 13 (6): 69–72 (in Russian)
- Darling J.D., McCallum J.C., Soden P.A., Korepta L., Guzman R.J., Wyers M.C., et al. Results for primary bypass versus primary angioplasty/stent for lower extremity chronic limb-threatening ischemia. J Vasc Surg. 2017; 66 (2): 466–75. DOI: https://doi.org/10.1016/j.jvs.2017.01.024
- Adam D.J., Beard J.D., Cleveland N., Bell J., Bradbury A.W., Forbes J.F., et al. Bypass versus angioplasty in severe ischemia of the lag (BASIL): multicentre, randomized controlled trial. Lancet. 2005; 366 (9501): 1925–34.