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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2013 June;20(2):97-103
Comparison between femoropopliteal bypass and subintimal recanalization in patients with intermittent claudication
Fialova J. 1, Utikal P. 1, Köcher M. 2, Indrakova J. 1, Vomackova K. 3, Cerna M. 2, Bachleda P. 1, Langova K. 4 ✉
1 Second Department of Surgery University Hospital Olomouc , Olomouc, Czech Republic;
2 Department of Radiology, University Hospital Olomouc , Olomouc, Czech Republic;
3 First Department of Surgery University Hospital Olomouc , Olomouc, Czech Republic;
4 Department of Biophysics, Medical Faculty Palacky University , Olomouc, Czech Republic
Aim: Revascularization in patients with intermittent claudication and long occlusions in the femoral region classified as TASC category C-D is classically performed by femoropopliteal bypass (FPB). An endovascular alternative is represented by subintimal recanalization (SIR). The aim of our work is to compare long-term results of FPB and SIR in patients with solely claudication.
Methods: Between January 2002 and December 2010, 196 patients with intermittent claudication with comparable SFA occlusion were indicated for revascularization. Two comparable groups of patients were created randomly.
Results: One-hundred-and twenty-eight above-knee FPB and eighty-four SIR of the femoral segment were performed. Technical success reached 100% in FPB and 97.6% in SIR. The mean follow-up was 41.3 months (ranging from 2-78 months). When comparing the bypass group, which was subdivided into group with revascularization using autologous vein and group with revascularization using ePTFE prosthesis, with the SIR group primary patency, primary assisted and secondary patency after 60 months were evaluated. The results for vein were 75%, 77.7% and 79.4%, for prosthesis 60.2% 60.2% and 76.3% and for the SIR group 36.7%, 40% and 39.4%. When comparing the number of occluded FPB and SIR, a statistically significant difference was observed in favor of FPB. When comparing the results of group with ePTFE prosthesis and SIR group was no statistically significant difference found.
Conclusion: In patients with intermittent claudication with long occlusions of the femoral segment, the method of choice is revascularization by FPB using an autologous vein. SIR demonstrated good patency and is an appropriate alternative for patients without a suitable autologous vein and with comorbidities which would contraindicate the patient for surgical revascularization.