Autovenous deep and common-popliteal bypass in the treatment of patients with critical limb ischemia
AbstractBackground. Autologous vein common femoral-popliteal bypass grafting remains the “gold standard” in the treatment of patients with obstructive atherosclerosis of the lower extremity vessels. Deep femoral-popliteal bypass grafting is less popular, but it offers several advantages over traditional interventions.
Objective. To determine the role of autologous vein deep and common femoral-popliteal bypass grafting in the treatment of patients with critical limb ischemia.
Patients and methods. We retrospectively examined the immediate and long-term results of autovenous femoropopliteal bypass grafting in 174 patients presenting with chronic critical limb ischemia and operated on in 2019–2023. Group 1 consisted of patients in whom the deep femoral artery was selected as the inflow artery (n=106), while Group 2 consisted of patients in whom the common femoral artery was selected as the inflow artery (n=68). The study groups were comparable in terms of key demographic and clinical parameters. The follow-up period was 24 months.
Results. In both groups, the distal anastomosis was more often formed with the P1 segment of the popliteal artery – 72 (67.9%) and 38 (55.9%) cases, respectively (p=0.108). Femoropopliteal bypass grafting was supplemented with an endovascular stage in 32 (30.2%) cases in Group 1, and in 29 (42.6%) cases in Group 2 (p=0.093). In Group 2, endovascular correction of the inflow tract was performed significantly more often (21.7% vs 14.7%), and in Group 1 – of the outflow tract (21.7% versus 14.7%) (p=0.004). The average duration of the operations in Groups 1 and 2 was 210 and 230 minutes, respectively (p=0.004). The average postoperative hospital stay was 11 and 13 days in Groups 1 and 2 (p=0.112).
Complications in the early postoperative period occurred in 39 (36.8%) and 30 (44.1%) patients (p=0.346). Amputations at the hip level were performed in 6 (5.7%) and 2 (2.9%) patients (p=0.404). Lethal outcome was recorded in 6 (5.7%) and 5 (7.4%) patients (p=0.618). Cumulative survival for 2 years was 62.4% and 66.1% of observations, respectively. Limb preservation for 24 months was 81.8% in Group 1 and 87.5% in Group 2 (p=0.440). Using the common femoral artery as an inflow artery was associated with a higher freedom from repeat revascularization – 82.9% vs 67.8% (p=0.111).
Conclusion. The advantages of deep femoral-popliteal bypass include the ability to shorten the venous conduit length and bypass scar tissue and major lymphatic vessels. Common femoral-popliteal bypass should be performed when reconstruction of the overlying arterial segment is planned, or when a distal anastomosis below the knee space is required.
Keywords:deep femoral artery; common femoral artery; femoropopliteal bypass grafting; critical limb ischemia; revascularization; lower extremity
Authors’ contribution. Study conception and design – Artyushin B.S., Bubnova N.A.; data collection and handling – Fadeeva E.A., Akhmedov T.M.; statistical processing – Fadeeva E.A., Polyakov D.D.; draft manuscript preparation – Fadeeva E.A., Ivanov A.S.; manuscript revision – Artyushin B.S., Eselevich R.V.
For citation: Artyushin B.S., Bubnova N.A., Fadeeva E.A., Ivanov A.S., Eselevich R.V., Polyakov D.D., Akhmedov T.M. Autovenous deep and common-popliteal bypass in the treatment of patients with critical limb ischemia. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2026; 32 (3): 104–11. DOI: https://doi.org/10.33029/1027-6661-2026-32-3-104-111
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