Author/Editor     Miksić, K; Flis, V; Pavlovič, M; Mrdja, B
Title     Arteriographic inoperability in chronic critical leg ischemia, when is surgical revision of occluded popliteal artery worth a trial?
Type     članek
Source     In: Schoevaerdts JC, Biglioli P, Schueler S, editors. Free papers of the 49th international congress of the European society for cardiovascular surgery; 2000 Jun 24-27; Dresden. Bologna: Monduzzi editore,
Publication year     2000
Volume     str. 465-70
Language     eng
Abstract     Purpose: The present study was carried out to determine the value of surgical revision of the popliteal artery in seemingly arteriographically verified inoperability of chronic critical Ieg ischemia. Patients and methods: ln the prospective study (1990 - 1998) 192 surgical revisions of the distal segment of the popliteal artery were performed in 183 patients with chronic critical leg ischemia. All patients had arteriographically verified obliteration of the popliteal artery and extensive occlusive lesions of all three main crural arteries. Patients selected for profundaplasty, distal revascularisation and primary amputation were excluded. Results: After arteriotomy at the distal part of the popliteal artery successful thromhendarterectomy (TEA) was perfonned in 139 operations. This segment of the popliteal artery was then used in 81 (42 %n) surgical reconstructions as distal anastomosis of femoro-popliteal bypass (Group 1). In 58 (30 %) autovenous patch closure of the popliteal arteriotomy was performed (Group 2). In 6 (4 %) popliteal revascularizations an additional arteriovenous fistula was created (3 in Group 1 and 2 in Group 2). ln 53 (28 %) surgical exposures, TEA of the distal popliteal artery was technically not possible (Group 3). The operative mortality for all patients was 9 %. Cumulative patency of vascular reconstruction for Group 1 at one month and one year was 73 % und 68 % respectively. For Group 2 it was 69 % and 53 % respectively. Cumulative limb salvage for all patients at one month and one year was 72 % and 53 % respectively. For Group 1 it was 86.5 % and 73 %, for Group 2 it was 83 % and 62 % and for Group 3 - 38 % and 9.5 % respectively. Conclusions: In patients with no evident contraindication, surgical revision and attempt of revascularisation of the distal segment of the popliteal artery is worth a trial even if arteriography shows extensive occlusion of the popliteal artery and the lower leg arteries.
Descriptors     ARTERIAL OCCLUSIVE DISEASES
POPLITEAL ARTERY
ISCHEMIA
LEG
ENDARTERECTOMY
ARTERIOVENOUS SHUNT, SURGICAL
TREATMENT OUTCOME