[Surgical tactics of treatment for chronic ischemia in patients with atherosclerotic lesions of the deep femoral artery and occlusion of the superficial femoral artery].

Abstract

Objective: The purpose of the study was to determine the tactics of surgical treatment of patients with lower limb ischemia and a hemodynamically significant lesion of the deep femoral artery and occlusion of the superficial femoral artery.

Patients and methods: The study is based on the retrospective results of examination and treatment of 99 patients suffering from chronic arterial insufficiency of the lower extremities. Of these, 31 (31.3%) patients had trophic ulcers and/or necrosis corresponding to categories 5 and 6 of chronic arterial insufficiency according to the R. Rutherford classification. All patients had occlusion of the superficial femoral artery and a hemodynamically significant stenosis of the common femoral artery, involving the deep femoral artery. 50 (50.5%) patients had hemodynamically significant impairment of the patency of ipsilateral iliac arteries. Revascularization of the limb was in all cases performed through the deep femoral artery by open or endovascular restoration of patency of the common femoral artery and the deep femoral artery. In the case of a hemodynamically significant lesion of the iliac artery, the operation was supplemented by its stenting. A new modified method - flow-guided femoroprofundoplasty - was performed in 28 (28%) patients. Therapeutic outcomes were evaluated during hospitalization, in the early postoperative period (1 month after surgery) and in the late postoperative period (from 6 months to 5 years).

Results: In the early postoperative period, complications developed in 11 (11%) patients, including 1 (1%) death. 91 (93%) patients had clinical improvement in the postoperative period, with regression of trophic disorders observed in 26 (84%) out of 31 patients. The five-year patency of the operated segment was 97%, with the limb-salvage and survival rates amounting to 100% and 76.9%, respectively. A predictor of effective revascularization through the deep femoral artery for critical lower limb ischemia turned out to be the presence of a patent recipient zone (p<0.001).

Conclusion: The results obtained indicate high efficiency of limb revascularization through the deep femoral artery. We do not recommend performing revascularization operations through the deep femoral artery in the absence of a recipient zone, as well as in the presence of trophic disorders corresponding to the 6th category of chronic arterial insufficiency according to R. Rutherford.