Endovascular versus Open Surgical Reconstruction in Long Segment Superficial Femoral Artery Occlusive Disease

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Endovascular versus Open Surgical Reconstruction in Long Segment Superficial Femoral Artery Occlusive Disease

Journal Title: The Egyptian Journal of Hospital Medicine - Year 2018, Vol 71, Issue 4

Abstract

Background: The concept of endovascular intervention has been well supported by the continuous advance in technology in long segment (superficial femoral artery) SFA occlusions. The rapid evolution of stent design, deployment approaches and adjunctive therapy made the practice of (percutaneous transluminal angioplasty) PTA safer and more predictable and has reduced superficial femoral artey surgery. Objectives: To compare the safety and effectiveness of endovascular treatment versus open surgical bypass in treatment of superficial femoral artery occlusive disease. Patients and Methods: This prospective study included 30 patients presenting to the Vascular Department in Cairo University Hospitals with femoropopliteal occlusive disease for whom percutaneous transluminal angioplasty with or without stenting was done for 15 cases. Femoropopliteal bypass surgery with saphenous or synthetic graft was done for 15 cases between March 2017 and January 2018. The procedure, possible complications, benefits, risks and other alternative interventions were all explained to the patients and an informed consent was obtained. Results: In endovascular cases: 1/15(6.66%) cases, developed small haematoma at the site of puncture which resolved by conservative management. After 6 months follow up,6/15 cases (40%) had intact pedal pulsation, 6/15 cases (40%) had popliteal pulsation with marked improvement of their complaints (disappearance of rest pain in 3 cases, the other 3 cases which had gangrene, line of demarcation appeared). 1/15 case (6.66%) showed popliteal pulse at 3 months follow up which disappeared at 6 months but the patient had good circulation with improvement of rest pain. So, successful cases were 13/15(86.66%) at 6 months follow up. 2 /15 cases(13.33%) showed occlusion, by Duplex 1 case of them showed occlusion of stent and 1 case showed return to original occlusion. In open surgical cases: Postoperative wound infection at groin incision developed in 3/15(20%) cases, 2 cases of them were managed conservatively by IV antibiotic and repeated dressing, and one developed secondary haemorrhage in which ligation of femoral artery was done and the limb became gangrenous and Above knee amputation was done. After 6 months follow up, 5/15 cases (33.33%) had intact pedal pulsation, 7/15 cases (46.66%) had popliteal pulsation with marked improvement of their complaints. Disappearance of rest pain occurred in 3 cases, while 3 cases which had gangrene, line of demarcation appeared and 1 case which had non healing ulcer, healing of ulcer started to occur. So successful cases 12/15(80%) at 6 months follow up. Thus, 3/15 cases (20%) failed, 1 case developed wound infection at groin incision followed by secondary haemorrhage in which ligation of the graft was done, the limb was worsen ended in above knee amputation. The other 2 cases showed occlusion of graft, 1 case ended in above knee amputation, the other below knee amputation was done in which the stump became gangrenous followed by above knee amputation. Conclusion: Percutaneous transluminal angioplasty (PTA) has obtained a definite place in the management of peripheral arterial occlusive disease of the lower limb. It was widely accepted as a first line of treatment for many patients with SFA occlusive disease. The low complication rate and relatively non-invasive nature of PTA made it an increasing popular intervention.

Authors and Affiliations

Eman Helal

Keywords

EP ID EP583903
DOI -
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