A comparative retrospective analysis of the results of hybrid interventions and femoral-tibial bypass in extended multi-level infrainguinal arterial segment lesions in patients with chronic critical limb ischemia

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Abstract

Background:  The traditional approach to the revascularization of the lower limb in critical ischemia (CLTI) caused by extended occlusion of the superficial femoral artery (SFA) in the passable popliteal artery (PA) and severe occlusive lesions of the tibial arteries suggests femoral-tibial bypass (FTB).

Materials and Methods: The clinical research included patients suffering from chronic limb threatening ischemia (CLTI) (chronic arterial insufficiency 4 stage), with extended (>20 cm) occlusion of the femoral-popliteal segment arteries and severe damage to the outflow pathways. The patients were divided in to two groups according to the criteria of the clinical picture and methods of surgical intervention.

Results: The 30-day mortality and graft failure rate were 2.5% vs 4.3% (p>0.05) and 5% vs 13% (p<0.05) after hybrid and tibial bypass interventions, respectively.

At 1 year the primary patency of bypass and amputation-free survival were 77.7% (95% CI 61.7-93.7) vs 57.1% (95% CI 42.9-71.3) and 82.1% (95% CI 66.8-97.4) vs 69.6% (95% CI 56.1-83.1) after hybrid intervention and tibial bypass, respectively (all non-significant).

Conclusions: Compared to femoral tibial bypass, a hybrid intervention comprised of a bypass to a patent popliteal artery and subsequent crural angioplasty decreased the early failure rate without any negative effect on the long-term outcomes in CLI patients with long SFA CTO and extensive runoff disease.

About the authors

Arshed Ahmad Kuchay

Saint Petersburg State Pediatric Medical University; City Hospital No. 14

Author for correspondence.
Email: drarshedcvs@gmail.com
ORCID iD: 0000-0002-7974-9369
SPIN-code: 5455-9033

MD, MS, Senior Lecturer at Department of Human Anatomy; Cardiovascular Surgeon, Clinical Researcher at City Limb Salvage Center

Russian Federation, Saint Petersburg; Saint Petersburg

Aleksandr N. Lipin

City Hospital No. 14; Kirov Military Medical Academy

Email: a_lipin2001@mail.ru
ORCID iD: 0000-0002-8347-8821
SPIN-code: 6751-9628

MD, PhD, Dr. Sci. (Medicine), Professor; Chairman of the City Limb Salvage Center

Russian Federation, Saint Petersburg; Saint Petersburg

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2. Fig. 1. Example of a simultaneous distal hybrid intervention performed on a 64-year-old patient with CLTI and deep trophic changes in the lateral plantar artery: a — the introducer 6F is introduced antegradely via the lateral branch of the functioning femoral-popliteal shunt/bypass (FPB); b — selective direct angiography of the arteries of the popliteal-tibial segment, performed through the introducer: occlusion of all three tibial arteries; c — recanalization stage of the posterior tibial artery: the injection of contrast material into the lateral plantar artery through the lumen of the balloon catheter; d — the final result of the endovascular intervention: all three tibial arteries are functioning; e — direct angiosomal foot revascularization

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