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Published on: January 26, 2024
[ISOLATED PROFUNDOPLASTY (DIFFERENTIAL CHOICE)]
V Rusyn1, V Rusyn1, F Horlenco1
1Higher State Educational Establishment of Ukraine "Uzhhorod National University", Uzhhorod, Ukraine.
Insights
Optimizing deep femoral artery (DFA) surgery improves outcomes for chronic lower extremity ischemia. Techniques vary by stenosis length, favoring endarterectomy for short lesions and bypass/prosthetics for extended ones.
Area of Science:
- Vascular Surgery
- Cardiovascular Diseases
- Arterial Reconstruction
Background:
- Chronic ischemia of lower extremities significantly impacts patient quality of life.
- Obliterating atherosclerosis of the femoropopliteal-tibial segment is a common cause.
- Optimizing surgical techniques for the deep femoral artery (DFA) is crucial for treatment success.
Purpose of the Study:
- To enhance treatment outcomes for patients with chronic lower extremity ischemia.
- To optimize surgical techniques for deep femoral artery (DFA) reconstruction.
Main Methods:
- Retrospective analysis of 150 patients undergoing surgery for femoropopliteal-tibial atherosclerosis (2014-2019).
- Surgical techniques included open endarterectomy with autovenous/autoarterial patches, bypass, and prosthetics of the DFA.
- Decision-making influenced by stenosis length, plaque density, and involvement of branching arteries.
Main Results:
- Short stenoses (<4 cm) treated with open endarterectomy (EAE) with autovenous/autoarterial patch or aloinsertion.
- Extended stenoses (4-10 cm) with soft/medium plaque: open EAE with autovenous patch.
- Long lesions (>10 cm): femoral-deep femoral shunting or prosthetics; reimplantation of branches if diameter ≥2 mm and retrograde flow preserved.
Conclusions:
- Tailoring DFA reconstruction techniques based on stenosis characteristics improves surgical outcomes.
- Open endarterectomy is suitable for shorter stenoses, while bypass or prosthetics are preferred for longer lesions.
- Consideration of branching artery status is vital for successful arterial reconstruction.
Abstract:
Objective - to improve the results of treatment of patients with chronic ischemia of the lower extremities based on optimization of the technique of operations on the deep femoral artery. During 6 years (from 2014 to the end of 2019), 150 patients were initially operated on for obliterating atherosclerosis of the femoropopliteal-tibial segment of the lower extremities in the department of vascular surgery of the Andrey Novak Regional Clinical Hospital, the clinical base of the Uzhgorod National University. In the presence of "short" stenoses, preference should be given to open endarterectomy with an autovenous and / or autoarterial patch. With extended stenoses, the essence of profundoplasty is again reduced to the restoration and expansion of the lumen by endarterectomy with an autovenous patch and/or by bypassing or prosthetics of the DFA segment. The choice of reconstruction is also influenced by the presence of enveloping and piercing branches at the site of the required level of disinfection. If the length of the DFA stenosis is up to 4 cm, regardless of the plaque density, it is recommended to open the EAE with autovenous, autoarterial and/or aloinsertion. With a stenosis length of 4 to 10 sm with a soft or medium density atherosclerotic plaque, an open EAE with an autovenous patch is shown. If the lesion is more than 10 cm long, regardless of the density of the atherosclerotic plaque, femoral-deep femoral shunting and/or prosthetics are recommended. When prosthetics of the DFA and the diameter of the perforating and/or circumflex arteries is ≥2 mm and the preserved retrograde blood flow, their reimplantation on the site into the prosthesis is indicated.
