Distal embolism during endovascular and hybrid reconstruction of extensive occlusion of the superficial femoral artery
AbstractObjective. The purpose of this study was to compare the incidence of distal embolization during two procedures of restoring blood flow through the superficial femoral artery (SFA): endovascular recanalization and open endarterectomy, both supplemented with paclitaxel-coated balloon angioplasty.
Patients and methods. Our prospective, randomized, single-center pilot study included 20 patients diagnosed as having extensive occlusions of the SFA. Group 1 patients (n=10) underwent SFA recanalization using percutaneous transluminal angioplasty with a drug-coated balloon (PTA + DCB). Group 2 patients (n=10) underwent semiclosed loop endarterectomy (LE) from the SFA followed by drug-coated balloon angioplasty (LE + DCB). Doppler ultrasonography was used to detect emboli during the revascularization procedure.
Results. The patients had no statistically significant differences in age, concomitant pathology, and severity of lower limb ischemia. The majority of patients had Rutherford class 3 chronic limb ischemia. The median number of emboli during the procedure in Group 1 and Group 2 patients amounted to 200.0 [100.0; 200.0] and 7 [6; 8], respectively, p=0.0002. Moreover, in Group 1, peripheral embolism occurred both during recanalization of the target artery (in 100% of cases) and during drug-coated balloon angioplasty (in 60% of cases), whereas in Group 2, peripheral embolism occurred only during drug-coated balloon angioplasty (100% of cases).
Conclusion. Endovascular recanalization of long-segment SFA occlusions followed by DCB angioplasty (PTA + DCB) was associated with a higher incidence of material distal embolism compared with the hybrid technique (LE + DCB).
Keywords: lower limb atherosclerosis; chronic lower limb ischemia; distal embolism; stenting; drug-coated balloons; percutaneous transluminal angioplasty
Funding. The study was financially supported by the Grants Council of the President of the Russian Federation, project No. MK-3982.2022.3.
Conflict of interest. The authors declare no conflicts of interest.
Authors’ contribution. Study conception and design – Karpenko A.A., Gostev A.A.; data collection and handling – Osipova O.S., Gostev A.A., Cheban A.V., Frykina O.E.; statistical processing – Gostev A.A., Osipova O.S., Cheban A.V.; draft manuscript preparation – Gostev A.A., Osipova O.S.; manuscript revision – Karpenko A.A.
For citation: Gostev A.A., Osipova O.S., Cheban A.V., Frykina O.E., Karpenko A.A. Distal embolism during endovascular and hybrid reconstruction of extensive occlusion of the superficial femoral artery. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2025; 31 (2): 18–25. DOI: https://doi.org/10.33029/1027-6661-2025-31-2-18-25
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