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REVIEW  ENDOVASCULAR TREATMENT OF LONG FEMOROPOPLITEAL DISEASE 

The Journal of Cardiovascular Surgery 2022 October;63(5):575-80

DOI: 10.23736/S0021-9509.22.12347-5

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Is open surgery still the first line of treatment for long femoropopliteal lesions?

Patrick NIERLICH 1 , Thomas HOELZENBEIN 2, Florian ENZMANN 3

1 Department of Surgery, LKH Mistelbach, Mistelbach, Austria; 2 Department of Surgery, Klinik Donaustadt, Vienna, Austria; 3 Department of Vascular Surgery, University Innsbruck, Innsbruck, Austria



INTRODUCTION: Treatment of long femoropopliteal lesions remains a challenge for vascular physicians as patients often present with multilevel complex pathologies and consequently face a high amputation risk and associated mortality. This review aimed to assess the current state of optimal revascularizations for the treatment of long femoropopliteal lesions.
EVIDENCE ACQUISITION: An online literature research of medical databases for original articles and review articles on open and endovascular revascularization of femoropopliteal lesions was conducted using mesh terms.
EVIDENCE SYNTHESIS: There has been an accumulation of evidence over the last years that endovascular treatment is a feasible and enduring alternative to open surgery for treatment of long femoropopliteal lesions if the lesions are restricted to the superficial femoral artery. But when disease extends to the infragenual level venous bypass remains superior with regards to long-term patency, clinical improvement and limb-salvage.
CONCLUSIONS: While the role of venous bypass as a first-line treatment might be declining, especially in frail patients or claudicants, the superior clinical improvement and amputation-free survival highlighted in several trials, demonstrate the relevance of bypass surgery. More randomized clinical trials are needed to verify the non-inferiority of endovascular treatment options to open surgery, especially when arterial disease extends below the knee.


KEY WORDS: Peripheral arterial disease; Chronic limb-threatening ischemia; Endovascular procedures; Angioplasty

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