Endovascular recanalization of chronic total occlusions of the native superficial femoral artery after failed femoropopliteal bypass in patients with critical limb ischemia

Roberto Minici; Michele Ammendola; Marisa Talarico; Maria Luposella; Marco Minici; Salvatore Ciranni; Giuseppe Guzzardi; Domenico Laganà

doi:10.1186/s42155-021-00256-0

Endovascular recanalization of chronic total occlusions of the native superficial femoral artery after failed femoropopliteal bypass in patients with critical limb ischemia

CVIR Endovasc. 2021 Sep 7;4(1):68. doi: 10.1186/s42155-021-00256-0.

Authors

Roberto Minici¹, Michele Ammendola², Marisa Talarico³, Maria Luposella⁴, Marco Minici⁵, Salvatore Ciranni⁶, Giuseppe Guzzardi⁷, Domenico Laganà⁸

Affiliations

¹ Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, Italy. robertominici@tiscali.it.
² Digestive Surgery Unit, Science of Health Department, Magna Graecia University, Catanzaro, Italy.
³ Cardiology Division, Giovanni Paolo II Hospital, Lamezia Terme, Italy.
⁴ Cardiovascular Disease Unit, San Giovanni di Dio Hospital, Crotone, Italy.
⁵ Institute for high performance computing and networking (ICAR), National Research Council (Cnr), Rende, Italy.
⁶ Vascular Surgery Division, University Hospital Mater Domini, Catanzaro, Italy.
⁷ Radiology Division, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy.
⁸ Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, Italy.

Abstract

Background: Femoropopliteal bypass occlusions are a significant issue in patients with critical limb ischemia and chronic total occlusion of the native superficial femoral artery, which challenges vascular surgeons and interventional radiologists. Performing a secondary femoropopliteal bypass is still considered the standard of care, although it is associated with a higher complication rate and lower patency rate in comparison with primary bypass. Over the past few years, angioplasty has been commonly used, with the development in endovascular technologies, to treat chronic total occlusions of the native superficial femoral artery, with a good technical success rate and clinical prognosis. The purpose of the study is to assess the outcome of endovascular recanalization of chronic total occlusions of the native superficial femoral artery, in patients unfit for surgery with critical limb ischemia after failed femoropopliteal bypass.

Results: A total of 54 patients were treated. 77.8 % of the conduits were PTFE grafts; the remainder were single-segment great saphenous veins. The most common clinical presentation was rest pain. Technical success was achieved in 51 (94.4 %) of 54 limbs. Angiographically, 77.8 % of the lesions were TASC II category D, while 22.2 % were TASC II category C. The average length of the native SFA lesions was 26.8 cm. Clinical success, with improved Rutherford classification staging, followed each case of technical success. The median follow-up value was 5.75 years (IQR, 1.5-7). By Kaplan-Meier survival analysis, primary patency rates were 61 % (± 0.07 SE) at 1 year and 46 % (± 0.07 SE) at 5 years. Secondary patency rates were 93 % (± 0.04 SE) at 1 year and 61 % (± 0.07 SE) at 5 years. Limb salvage rates were 94 % (± 0.03 SE) at 1 year and 88 % (± 0.05 SE) at 5 years.

Conclusions: The endovascular recanalization of chronic total occlusions (CTO) of the native superficial femoral artery (SFA) after a failed femoropopliteal bypass is a safe and effective therapeutic option in patients unfit for surgery with critical limb ischemia.

Keywords: Chronic total occlusion; Critical limb ischemia; Endovascular recanalization; Femoropopliteal bypass occlusion; Native SFA recanalization.