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Online ISSN 1827-1847
Volpe P. 1, Conti B. 2, Palazzo V. 1, Ruggirei M. 1, Marinucci R. 1, Magistero G. 1, Sembrano L. 1, Vitulano N. 3, Paroni G. 1
1 Department of Vascular Surgery IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo, Foggia, Italy
2 Department of Vascular Surgery Ospedale degli Infermi, Biella, Italy
3 Department of Cardiology Sacro Cuore Catholic University Gemelli Polyclinic, Rome, Italy
Aim. The greatest knowledge of the endovascular methods acquired by the vascular surgeons has allowed the realization, even more frequent, of so-called hybrid techniques, in which the endovascular procedure is associated with the traditional surgery. These procedures allow less invasive approaches to treatment of complex arterial lesions, improvement of the bypass inflow and/or outflow and, therefore, open new therapeutic opportunities in limb salvage. The purpose of this study was to evaluate the efficacy of combining above knee femoro-popliteal bypass with below knee angioplasty in critical lower limb ischemia.
Methods. From February 2006 to February 2007 18 combined above knee femoro-popliteal prosthetic bypasses and distal angioplasty have been performed, out of which 12 were performed on tibial arteries and 6 revascularization on popliteal and tibial vessels in 18 patients (16 males; average age 5.5 years, range 69-82 years). All the patients suffered from critical ischemia (ischemic ulcers/gangrenes); 72% suffered from diabetes mellitus type I and 44% from chronic renal failure (1 patient was in hemodialitic treatment). Angiographic study was performed prior the combined procedure. The follow-up was performed by means of clinical examination and echo-color-Doppler at 3-6-12-24 months (min. 12 and max. 24 months).
Results. Procedural success was achieved in 100% of cases. The primary patency rate was 91% and 77% at 6 and 12 months; in 6 cases the primary and secondary patency rate was 84% and 100%, respectively, at 24 months. The limb salvage rate was 95% at 12 months.
Conclusion. Combining above knee femoro-popliteal bypass with distal popliteo-tibial angioplasty could be more advantageous and less invasive for those patients who suffer from critical ischemia, concurrent diseases and long lesions of femoral superficial artery and vessels of the leg, because: 1) the bypass assures a better primary patency than angioplasty at one year in case of long lesions of the femoral superficial; 2) in above knee bypass the synthetic prosthesis gives same results of long term patency to autologous vein; 3) distal angioplasty improves the outflow of bypass and accelerates recovery of trophic lesions.