When Are Endovascular and Open Bypass Treatments Preferred for Femoropopliteal Occlusive Disease?

Abstract

Several meta-analyses and multicenter trials have shown that chronic limb ischemia did not occur for up to 5 years in 50%–70% of patients who underwent saphenous vein grafts, with limb salvage and perioperative mortality rates of >80% and 3%, respectively. However, open surgical bypass can have limitations, including postoperative morbidity/wound complications of 10%–20% and prolonged length of hospital stay and outpatient care. Several studies have analyzed clinical outcomes for patients with critical limb ischemia treated with endovascular therapies, but they have been mainly retrospective with significant heterogeneity or were single center. Only few randomized trials have compared surgical vs. endovascular therapy. These included the Bypass vs. Angioplasty in Severe Ischemia of the Leg (BASIL) trial, with no differences found in amputation-free or overall survival rates at 1 year; however, late outcomes favored the surgical group. The Bypass or Angioplasty in Severe Intermittent Claudication (BASIC) trial concluded that the 1-year patency rates were 82% and 43% for bypass and angioplasty, respectively. The BEST Endovascular vs. Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial is currently enrolling patients. This review analyzed studies comparing open vs. endovascular therapy in patients with femoropopliteal disease. (This is a review article based on the invited lecture of the 45th Annual Meeting of Japanese Society for Vascular Surgery.)

Curativo com filme e gel de biopolímero de celulose bacteriana no tratamento de feridas isquêmicas após revascularização de membros inferiores.

“…Most patients with IW are candidates for open or endovascular arterial revascularization surgery, which aims to restore blood flow to the lower limb and thus avoid major amputations (above the ankle joint), which cause a significant deterioration in quality of life and increased mortality. Hardly accessible, alternative therapy already exists, such as the use of stem cells, but this is still not able to replace revascularization procedures [1][2][3] .…”

“…In addition to arterial revascularization surgery, patients with IW often undergo surgical debridement and minor amputations. These procedures are performed after revascularization surgeries and aim to promote the removal of devitalized and infected tissues, and to facilitate the healing process [1][2][3] . Thus, there is need for dressings, performed at the outpatient level.…”

“…There are many materials used in these dressings, most also used in venous and lymphatic ulcers. There is no standardization as to the material used in the dressings of such wounds, and several protocols are used [1][2][3] .…”

Nitinol Self-Expanding Stents for the Treatment of Obstructive Superficial Femoral Artery Disease: Three-Year Results of the RELIABLE Japanese Multicenter Study

“…Patients were treated based on clinical symptoms and lesion morphology; all lesions were classified as TASC A–C, and were successfully treated endovascularly. 7 ) Seven patients had an additional stent placed (11 stents) while the remaining patients received repeat PTA or additional endovascular therapy (e.g., laser atherectomy). The mean residual stenosis following the revascularization procedure was 13.6±15.2%.…”

“… 4 ) Revascularization is often indicated if medical therapy and exercise do not relieve symptoms. 5 ) Endovascular therapy (EVT), less invasive than surgery with a low risk of complications, has become the primary method of revascularization for TASC A–C lesions 6 , 7 ) ; bypass surgery still has a place in more complex, multilevel, TASC D lesions. 8 ) Nearly 50% of patients referred for revascularization have a lesion in the superficial femoral artery (SFA).…”