OBJECTIVE
To analyze in-hospital results of endovascular treatment of severe deep femoral artery lesions combined with extended femoropopliteal occlusion in comorbid patients with critical lower limb ischemia.
MATERIAL AND METHODS
A single-center non-randomized prospective study included 51 patients aged 71±8 years with deep femoral artery (DFA) lesions and extensive occlusion of superficial femoral artery (SFA), popliteal artery (PA) and tibial arteries between January 2017 and April 2021. Preoperative trophic lesions were registered in 15 (30%) patients, rest pain — in 36 (70%) patients. All ones underwent previous at least one ipsilateral reconstructive intervention. Comorbidity was determined by age and concomitant diseases. According to preoperative CT angiography, all patients had SFA occlusion, 36 (70.5%) patients — occlusion of SFA and PA, 4 (8%) patients — occlusion of SFA, PA and tibioperoneal trunk, 11 (21%) patients — occlusion of SFA, PA, tibioperoneal trunk and one tibial artery. DFA occlusion was detected in 24 (47%) patients, stenosis >70% — in other cases (53%). Mean length of DFA lesion was 37±24 mm.
RESULTS
All patients underwent endovascular correction of DFA lesions. Patients with trophic ulcers underwent complete endovascular correction of femoropopliteal segment and revascularization of deep femoral artery. Technical success rate was 100%. Early postoperative period was uneventful in 100% of cases. Among patients with ischemia Fontein grade 3 (n=36), pain relief occurred in 35 (97%) ones. Among 11 patients with ischemia grade 4, healing of trophic lesions was noted in 9 (82%) patients. Minor amputation in postoperative period was required in 2 (4%) patients. There were no in-hospital deaths.
CONCLUSION
Endovascular correction of severe DFA lesions combined with extended occlusion of femoropopliteal segment is an effective and safe alternative to open surgical treatment in patients with critical lower limb ischemia. Clinical outcomes in comorbid patients with previous ipsilateral reconstructive interventions are characterized by acceptable pain relief and healing of trophic changes (97% and 82%, respectively).
