Methods for improving the results of using a synthetic prosthesis in the popliteal-tibial segment in critical limb ischemia

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Abstract

Aim. Analysis of immediate and long-term results of using a synthetic prosthesis for femoral-distal-popliteal and tibial bypass grafting in patients with critical lower limb ischemia.

Materials and Methods. Patients with symptoms of chronic arterial ischemia of the lower extremities in the stage of critical ischemia (n = 109) were operated at the university surgical clinic on the base of D.D. Pletnev City Clinical Hospital, Moscow, in the period from 2009 to 2017. All the patients underwent the operation of femoral-distal popliteal or femoral-tibial bypass grafting using a synthetic explant (PTFE). Shunting with a synthetic prosthesis was performed in 33 (30.3%) patients, and in 76 (69.7%) cases a combination of an explant with a section of autovein was used in the form of a combined shunt in 44 patients (40.4%) (synthetic prosthesis + autovein) or a patch- or cuff plasty of distal anastomosis in 32 patients (29.3 %). In 14 (12.8%) patients of both groups, the intervention was supplemented by intraoperative balloon angioplasty of the lower leg arteries. Long-term results were evaluated within the period up to 5 years after surgery. Kaplan-Meyer survival analysis was used for the calculation of results.

Results. The cumulative 5-year patency of the synthetic prosthesis was 42.9%. However, use of the prosthesis in combination with the autovein section in the form of a combined shunt or plastic surgery of the distal anastomosis significantly improved the values of cumulative patency (54.5%) and limb retention (83.6%).

Conclusions. The results obtained make it possible to recommend the use of a synthetic prosthesis in combination with an autovenous plastic surgery of a distal anastomosis or by combining a prosthesis with a small section of an autovein in the absence of a complete autovein. Regular monitoring of such shunts in the long-term period and timely follow-up interventions are necessary for improving long-term results.

About the authors

Andrey A. Matyushkin

Russian National Research Medical University named after N. I. Pirogov; City Clinical Hospital named after D.D. Pletnev

Author for correspondence.
Email: iplobachev@yandex.ru
ORCID iD: 0000-0002-4112-7732
SPIN-code: 5794-6214
ResearcherId: B-7734-2018

MD, professor of the department of faculty surgery of the pediatric faculty, MD, head of the department of vascular surgery

Russian Federation, Moscow

Alexey A. Lobachev

City Clinical Hospital named after the Bakhrushin brothers

Email: iplobachev@yandex.ru
ORCID iD: 0000-0002-1361-9967

MD, PhD, Head of the Surgical Department of the Polyclinic

Russian Federation, Moscow

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Supplementary files

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2. Fig. 4. Disorder in microcirculation of the left foot of patient M., 70 years old, in the form of pronounced paleness of skin in the horizontal position

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3. Fig. 1. Stages of formation of distal anastomosis of Linton patch type: A – plasty of the artery with autovenous insert; B – patchtomy; C – anastomose between synthetic prosthesis and patch; D – completion of the anastomosis

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4. Fig. 2. Cumulative patency of synthetic prostheses in the studied groups within 60 months of observation

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5. Fig. 3. Limb salvage in the studied groups within 60 months of observation

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6. Fig. 5. Angiograms of patient M., 70 years old: А – aorto-iliac segment, without hemodynamically significant stenosis; B – occlusion of the superficial femoral artery (shown by arrow); C – hemodynamically significant stenosis of the popliteal artery (shown by arrow); D – shin arteries (shown by arrow), distal peripheral resistance evaluated as 3 points

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7. Fig. 6. Stages of surgical intervention in patient M., 70 years old: A - forming a patch for wide arteriotomy; B - an anastomosis of the end-to-side type between the patch and the prosthesis is formed

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Copyright (c) 2020 Matyushkin A.A., Lobachev A.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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