Lower extremity revascularization for long occlusive lesions of femoral and crural arteries
AbstractFunding. The study had no financial support.
Conflict of interest. The authors declare no conflict of interest.
Authors’ contribution. Study conception and design – Fokin A.A., Fomin V.S., Maslyanyuk O.V.; data collection and handling – Fomin V.S., Kudryavtsev O.I., Oleksyk I.B.; statistical processing – Tishkov A.V.; draft manuscript preparation – Fomin V.S.; manuscript revision – Fokin A.A., Laptev K.V.
For citation: Fomin V.S., Maslyanyuk O.V., Oleksyk I.B., Kudryavtsev O.I., Tishkov A.V., Laptev K.V., Fokin A.A. Lower extremity revascularization for long occlusive lesions of femoral and crural arteries. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2025; 31 (3): 93–101. DOI: https://doi.org/10.33029/1027-6661-2025-31-3-93-101
Keywords: obliterating atherosclerosis of lower-limb arteries; autovenous femoropopliteal bypass grafting; loop endarterectomy; balloon angioplasty and stenting; critical lower-limb ischemia
Objective. To assess efficacy of a method of modified open reconstruction of femoral and crural arteries in the absence of an autovein suitable for revascularization.
Patients and methods. The study included a total of 78 patients subjected to open arterial reconstruction. The duration of the postoperative follow-up amounted to 36 months and more. The patients were divided into 3 groups: Group 1 comprised 18 patients who underwent amodified operation including popliteal distal bypass grafting with an autovein and retrograde (or antegrade) semiclosed loop endarterectomy from the superficial femoral artery; Group 2 was composed of 29 patients subjected to classical femoropopliteal bypass grafting with a reversed great saphenous vein below the knee-joint fissure; and Group 3 consisted of 31 patients who endured X-ray endovascular reconstruction including balloon angioplasty with possible stenting of the superficial femoral artery and popliteal artery.
Results. Primary patency of the arterial bed at 1, 2 and 3 years of follow-up in Group 1 amounted to 80.9% (out of 21 patients), 75% (out of 20 patients) and 72.2% (out of 18 patients), respectively. Secondary patency after 3 years was 100%. The limb salvage rates at 1, 2 and 3 years of follow-up in Group 1 amounted to 90.4% (out of 21 patients), 85% (of 20 patients) and 88.8% (out of 18 patients), respectively.
Primary patency at 1, 2 and 3 years of follow-up in Group 2 was 81.3% (out of 33 patients), 76.6% (out of 33 patients) and 68.9% (out of 29 patients), respectively. Secondary patency after 3 years amounted to 80%. The limb salvage rates at 1, 2 and 3 years of follow-up in Group 2 were 87.87% (out of 33 patients), 86.6% (out of 30 patients) and 86.2% (out of 18 patients), respectively.
Primary patency of the arterial bed at 1, 2 and 3 years of follow-up in Group 3 amounted to 83.7% (out of 37 patients), 64.7% (out of 34 patients) and 48.3% (out of 31 patients), respectively. Secondary patency after 3 years was 90%. The limb salvage rates at 1, 2 and 3 years of follow-up in Group 3 amounted to 89.1% (out of 37 patients), 85.2% (out of 34patients) and 83.87% (out of 31 patients), respectively.
Conclusion. Performing modified open arterial reconstruction by means of the proposed method makes it possible to restore blood flow in the ischemized extremity with a long occlusive lesion of femoral and crural arteries. The remote results (36 months) are suggestive of efficacy of the developed technique.
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