[Surgical tactics for repeated interventions on the arteries of the femoral-popliteal segment]

The aim is to evaluate the effectiveness of various operations during repeated interventions in patients with occlusion of the superficial femoral artery.

The results of treatment of 28 patients who underwent repeated reconstructive surgery for occlusion of the superficial femoral artery (SBA) were analyzed. The patients were divided into 2 groups: Group 1 - patients who underwent loop endarterectomy from the PBA and removal of the thrombosed femoral-popliteal shunt (n=12); Group 2 - patients who underwent repeated bypass surgery with an autovene or prosthesis (n=16).

The median time from the moment of primary surgery to the second intervention was 16 months in group 1 and 17 months in group 2 (p=0.434). In group 1, no thrombosis, death, or other cardiovascular event was recorded in the early postoperative period. In group 2, in the early postoperative period, 1 patient developed prosthetic thrombosis again, and 1 more reconstructive operation was performed to form a distal anastomosis on the lower leg. There were also no major cardiovascular events or deaths in group 2. Patency in the period of 12, 36, and 60 months was 92.6, 92.6, and 75% in group 1 (loop endarterectomy from PBA), respectively. In group 2 (repeated femoral-popliteal bypass surgery), bypass patency was 81.3, 68.8, and 62.5%, respectively (p=0.262). Freedom from amputation was 100, 100, and 91.7% in group 1 at 12, 36, and 60 months, and 81.3, 75, and 75% in those groups. the same time frame, respectively (p=0.114).

In case of thrombosis of the initially formed femoral-popliteal shunts, a loop endarterectomy from the superficial femoral artery may be recommended as a repeat operation, which is as effective as the method of repeated femoral-popliteal shunts.