[AUTOVENOUS REVASCULARIZATION OF THE LOWER EXTREMITY ARTERIES IN PATIENTS WITH VARIANT ANATOMY OF THE PERIPHERAL
V A Yudin1, S A Vinogradov2, A A Krylov1
1Ryazan State Medical University named after academican I. P. Pavlov, 390026, Ryazan, Russia.
Insights
Severe lower limb artery disease, often from atherosclerosis, can lead to limb loss. This case highlights successful surgical revascularization using reversed vein grafts, preserving limbs and improving life quality.
Area of Science:
- Vascular Surgery
- Cardiovascular Disease
- Atherosclerosis Research
Background:
- Obliterating arterial diseases significantly contribute to cardiovascular morbidity in developed nations.
- Progressive obliterating atherosclerosis leads to critical lower limb ischemia, jeopardizing limb and life prognosis.
- Surgical options include endovascular and open reconstructive interventions, with treatment choice guided by lesion characteristics.
Purpose of the Study:
- To present a clinical case of successful staged revascularization for advanced infrainguinal arterial lesions.
- To demonstrate the efficacy of reversed vein grafting in complex femoropopliteal reconstructions.
- To highlight the advantages of surgical tactics in limb salvage and quality of life improvement.
Main Methods:
- A staged revascularization procedure using reversed great saphenous vein grafts was performed on both lower extremities.
- The intervention followed failed conservative treatment and endovascular attempts.
- A novel popliteal artery bifurcation was created for distal anastomosis below the knee, considering high anterior tibial artery outflow.
Main Results:
- Successful limb salvage and improved patient quality of life were achieved through the surgical intervention.
- The use of autovenous grafts demonstrated superior long-term patency compared to synthetic prostheses (71% vs. 44% at 5 years for distal bypass).
- The case highlights the successful management of complex femoropopliteal disease with a unique surgical approach.
Conclusions:
- Open reconstructive surgery, particularly with autovenous grafts, remains a recommended approach for extended superficial femoral artery occlusions.
- Staged revascularization with reversed vein grafts can be highly effective in managing complex infrainguinal atherosclerotic disease.
- This clinical case underscores the benefits of invasive surgical strategies for limb preservation and enhancing patient outcomes.
Abstract:
Obliterating diseases of the lower extremity arteries occupy a high proportion in the structure of cardiovascular morbidity in the population among the developed countries. The steadily progressing course of obliterating atherosclerosis leads to the critical lower limb ischemia and causes an unfavorable prognosis for preserving the extremity, as well as the patient's life. Nowadays, there are two ways of surgical management of this pathology: endovascular and open reconstructive interventions. The choice of the method is based on a comprehensive keeping of the patient-specific records, including the anatomical characterization of the arterial bed lesions. In case of extended occlusion of the superficial femoral artery, the open reconstructive surgery using a large saphenous vein as a transplant is recommended. This circumstance is confirmed by the autovein patency in the long term compared with a synthetic prosthesis according to the results of randomized clinical trials. Therefore, with the formation of a distal anastomosis below the gap of the knee joint, the patency of the autovein and synthetic prosthesis after 5 years is 71% and 44% respectively. In this article, we represent a clinical case of successful treatment of a patient with progression of atherosclerotic lesions of the infrainguinal segment arteries. A staged revascularization of the femoral-popliteal segment arteries using technique of a reversed vein on both lower extremities after attempts of the conservative treatment and x-ray endovascular intervention was performed. A feature of this case is the creation of a new bifurcation of the popliteal artery during the formation of a distal anastomosis below the fissure of the knee joint under the contitions of a high discharge of the anterior tibial artery.The given clinical case demonstrates the advantages of invasive surgical tactics with the aim of preserving the limb and improving the patient's quality of life.
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