Annals of vascular surgery | 2019
Ipsilateral Antegrade Angioplasty for Flush Superficial Femoral Artery Occlusion versus Open Bypass Surgery.
Abstract
BACKGROUND\nManagement of superficial femoral artery flush occlusion using the ipsilateral-antegrade approach is challenging. The study aimed to assess technical feasibility, patency and limb salvage of ipsilateral antegrade angioplasty versus surgery for this lesion in patients with lifestyle-limiting claudications and critical limb ischemia.\n\n\nMETHODS\nBetween June 2015 and March 2018, 53 patients were randomized to either ipsilateral antegrade angioplasty; n= 28, or surgical bypass; n= 25. We included patients with Trans-Atlantic Inter-Society Consensus II B, C or D lesions, having a patent popliteal artery. Technical success, patency, limb salvage and major adverse events were assessed during the 12-months follow-up.\n\n\nRESULTS\nThe technical success was 100% and 89.3% in the surgical and endovascular groups, respectively, p = 0.238. At 12-months, the primary, assisted and secondary patency rates were 72% vs. 64.5%, 78.2% vs. 74.7%, and 81.6% vs. 74.2% in surgical versus endovascular groups, respectively, without significant differences between both groups. Limb salvage was 88% versus 92% in surgical versus endovascular group, respectively, p = 0.564. The length of hospital stay was longer in the surgical versus the endovascular group; 6,24 ± 0.37 versus 1.84±0.19 days, respectively, p = 0.001. Local complications were higher in the surgical group, p = 0.046.\n\n\nCONCLUSIONS\nTechnical success, patency and limb salvage of endovascular approach were comparable to surgical bypass. The endovascular approach had the advantages of reduced local complications and hospitalization.