PP34. Inflow and Outflow Improvement by Endovascular Procedures During Surgical Revascularization of Lower Limbs

Article Outline

• Background
• Methods
• Results
• Conclusions
• Copyright

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Background 

Endovascular revascularization techniques (ERT) are increasingly performed in the treatment of critical limb ischemia (CLI), however their role as an adjunct to open surgical revascularizations (OSR), has been scarcely investigated, particularly as a method to improve outflow. We have evaluated early and long-term results of CLI revascularization obtained by OSR with either proximal or distal simultaneous ERT.

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Methods 

A series of consecutive patients undergoing simultaneous OSR and ERT for CLI have been prospectively evaluated. Cases were divided into three groups: GI: inflow procedures - ERT was performed proximally to the proximal anastomosis of OSR; GII combined procedures - profundoplasty and distal ERT; GIII - proximal OSR and distal ERT. Choice for simultaneous ERT was made when a sufficient length of autologous graft was unavailable or in order to significantly reduce the magnitude of OSR. Results have been evaluated clinically and by duplex scanning perioperatively and at 3, 6, 12, 18, 24 and 36 months and calculated by life table analysis. Differences between groups were assessed by log-rank test.

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Results 

In a series of 867 treatments for CLI, simultaneous OSR and ERT were performed in 52 cases (5.9%) (GI: 23 - 44.2%, GII 11 - 21.1%, and GIII 16 - 30.7%), with perioperative patency of 100%. Follow-up was available in 50 cases (94%) for a mean of 11.5 ± 8.8 months. Overall patency and survival at 36 months were 59.5% and 79.6% respectively (GI: 74.1% and 70.8%, GII 60.6% and 90.9%, GIII 34.4% and 100%, p=0.16 and 0.54 between groups).

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Conclusions 

Regardless of the strategy utilized, ERT are a valuable adjunct to OSR and may help to minimize the impact of OSR. Early and long-term results in cases with known unfavourable expectation are encouraging. Inflow and outflow ERT have similar impact on results.