Comparison of bypass versus primary angioplasty for lower extremity chronic limb-threatening peripheral arterial diseases

Year 2021, , 383 - 387, 21.05.2021

Mustafa Özer Ulukan , Atalay Karakaya , Murat Uğurlucan , Korhan Erkanlı

https://doi.org/10.32322/jhsm.915411

Abstract

Aim: Peripheral arterial Diseases (PAD) is seen frequently with increasing age, and have a prevalence of about 20% over 70 years of age. We aimed the results of two different treatment approaches as open surgical procedures and radiological interventions.
Methods: We reviewed the data of PAD from the online data system of the hospital. The patients treated by endovascular femoropopliteal revascularization versus open surgical femoropopliteal graft bypass between January 2016 and December 2019 were enrolled in to study. Eighty limbs of 67 patients with the symptomatic severe occlusive disease and results were evaluated in the aspect of reducing ischemia and prevention of amputation in this retrospective study.
Results: 67 patients were divided into two groups. Group 1(n=29) was the interventional PTA/S group, group 2 (n=38) was the open surgical bypass group. 8 of the patients in Group 2 and 5 of patients in Group 1 had bilateral lesions. Patients were at a mean age of 63.44±8.98 years. The mean time of hospitalization time was significantly longer following a first-time bypass (10 vs. 8 days). The success of results was ending of claudication and ischemia and prevention of amputation of an extremity. In these aspects, there was no difference between procedure types.
Conclusion: In the aspect of the length of hospital stay and infection, interventional procedures seem more benefit however in long-term evaluation, freedom from reintervention or redo bypass was significantly higher in the bypass group (92% vs 79 % p<0,01).

Keywords

peripheral arterial diseases, angioplasty, peripheral bypass surgery

References

• Cheanvechai V, Harthun NL, Graham LM, et.al. Incidence of peripheral vascular disease in women: is it different from that in men? J Thorac Cardiovasc Surg 2004; 127: 2: 314-17.
• D. Darling, John C. McCallum, et al. Results for primary bypass versus primary angioplasty/stent for lower extremity chronic limb-threatening ischemia Jeremy. J Vasc Surg 2017; 66: 466–75.
• Albers M, Romiti M, Brochado-Neto FC, et al. Meta-analysis of alternate autologous vein bypass grafts to infrapopliteal arteries. J Vasc Surg 2005; 42: 449–55.
• Papavassiliou VG, Walker SR, Bolia A, et al. Techniques for the endovascular management of complications following lower limb percutaneous transluminal angioplasty. Eur J Vasc Endovasc Surg 2003; 25: 125–30.
• Robert S. Dieter, Raymond A. Dieter, Jr. Endovascular Interventions: A Case-Based Approach. editör: III.2014; 62.765.
• Jackson MJ, Wolfe JH. Are infra-inguinal angioplasty and surgery comparable? Acta Chir Belg 2001; 101: 6-10.
• Suraj Wasudeo Nagre, Abhilash J. Long segment femoral endarterectomy with aorto bifemoral bypass grafting for advanced bilateral lower limb peripheral vascular disease in a young male. Vascul Dis Ther 2017; 3: 1-3.
• Jang BW, Suh KJ, Kim TH, et al. Percutaneous transluminal angioplasty of ilio-femoro-popliteal artery. J Korean Radiol Soc. 1987; 23: 40-7.
• Habeb M, Agaç MT, Aliyev F. et al. Anadolu Kardiyol Derg 2005; 5: 124-29.
• Bradbury AW, Adam DJ, Bell J, et al. Bypass versus Angioplasty in Severe Ischaemia of the Leg [BASIL] trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg 2010; 51: 5-17.
• Cassim MRN, Godahewa S, Paviththiran S, et al. Percutaneous transluminal lower limb angioplasty [PTA] for chronic limb threatening ischemia [CLTI] in a low resource setting 4-year experience. Sri Lanka J Surg 2020; 38: 13-20.
• Sargın G, Tanrıverdi O. A brief overlook at the radial artery catheterization. Med Bull Haseki 2011; 49: 93-5