ORIGINAL ARTICLES   

Giornale Italiano di Chirurgia Vascolare 1999 June;6(2):93-103

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English, Italian

Indications and limitations of endovascular surgery in the infrageniculate district

Domanin M., Lorenzi G., Gabrielli L., Costantini A., Molinari A., Sala P., Agrifoglio G.

From the Institute of Vascular Surgery and Angiology University of Milan, Italy

Aims. A ret­ro­spec­tive anal­y­sis of the ­results of endo­vas­cu­lar ther­a­py in the treat­ment of pri­mary and post­op­er­a­tive ­lesions of the dis­tal arter­ies.
Methods. The ­study includ­ed 55 ­patients under­go­ing endo­vas­cu­lar treat­ment of the infra­ge­nic­u­late pop­li­teal ­artery, the tibi­al arter­ies or pre­vi­ous femor­o­dis­tal bypass­es. The pop­u­la­tion was sub­di­vid­ed on the ­basis of the asso­ci­a­tion or oth­er­wise ­with revas­cu­lar­isa­tion sur­gery (28 (51.0%) vs 27 (49.0%)), or on the ­basis of ­redo sur­gery or pri­mary oper­a­tions (21 (38.1%) vs 34 (61.9%)).
Results. Immediate tech­ni­cal suc­cess was ­achieved in 67.3% of cas­es ­with a paten­cy of 38.2% ­after 2 ­years. In ­terms of endo­vas­cu­lar pro­ce­dures ­alone, clin­i­cal suc­cess was ­achieved in 78.1% and 53.0% ­after 2 ­years. In endo­vas­cu­lar pro­ce­dures asso­ciat­ed ­with con­ven­tion­al sur­gery, imme­di­ate paten­cy was 62.5% (p<0.001) and 16.2% at 2 ­years (p<0.001). In pri­mary pro­ce­dures, imme­di­ate clin­i­cal suc­cess was ­obtained in 73.9% and 48.3% at 2 ­years. The imme­di­ate ­result of ­redo pro­ce­dures was 52.2% (p<0.001) and 19.2% at 2 ­years (p<0.001). Limb sal­vage in the ­event of ­redo sur­gery was ­achieved in 82.6% imme­di­ate­ly ­after sur­gery and 61.4% at 2 ­years, com­pared to 87.5% (n.s.) imme­di­ate­ly ­after sur­gery and 68.6% at 2 ­years (n.s.) in pri­mary sur­gery.
Conclusions. Segmentary pri­mary ­lesions can be treat­ed ­with ­good ­results in ­terms of imme­di­ate and ­long-­term paten­cy, where­as in the ­case of asso­ciat­ed pro­ce­dures or ­redo sur­gery, the ­results are val­id if eval­u­at­ed in ­terms of ­limb sal­vage.