EXTRAANATOMIC CROSSOVER AUTOVENOUS BYPASS — RECONSTRUCTION OF THE RESERVE IN PATIENTS WITH A HIGH RISK OF AMPUTATION AND LOW LIFE EXPECTANCY OR AN ALTERNATIVE TO TRADITIONAL TREATMENT?

  • A.G. Borisov Limb Salvage Center, City Hospital № 14 Kosinova st., 19/9, Saint Petersburg, Russian Federation, 198099 https://orcid.org/0009-0003-3900-2652
  • A.V. Atmadzas Limb Salvage Center, City Hospital № 14 Kosinova st., 19/9, Saint Petersburg, Russian Federation, 198099
  • N.N. Gruzdev Limb Salvage Center, City Hospital № 14 Kosinova st., 19/9, Saint Petersburg, Russian Federation, 198099
  • V.B. Kozhevnikov Limb Salvage Center, City Hospital № 14 Kosinova st., 19/9, Saint Petersburg, Russian Federation, 198099
  • A.A. Kuchay Limb Salvage Center, City Hospital № 14 Kosinova st., 19/9, Saint Petersburg, Russian Federation, 198099
  • A.N. Lipin Limb Salvage Center, City Hospital № 14 Kosinova st., 19/9, Saint Petersburg, Russian Federation, 198099
  • A.G. Orlov Limb Salvage Center, City Hospital № 14 Kosinova st., 19/9, Saint Petersburg, Russian Federation, 198099
  • S.E. Pak North-Western Medical University named after I.I. Mechnikov. Kirochnaya 41, Saint Petersburg, Russian Federation, 191015
  • R.S. Sobolev Limb Salvage Center, City Hospital № 14 Kosinova st., 19/9, Saint Petersburg, Russian Federation, 198099
  • Ya.P. Eminov Limb Salvage Center, City Hospital № 14 Kosinova st., 19/9, Saint Petersburg, Russian Federation, 198099
  • I.M. Khokhlova Limb Salvage Center, City Hospital № 14 Kosinova st., 19/9, Saint Petersburg, Russian Federation, 198099
DOI: https://doi.org/10.56871/RBR.2024.67.22.002
Keywords: atherosclerosis, chronic limb threatening ischemia, extraanatomic bypass, autogenous vein bypass

Abstract

Introducion. Critical limb threatening ischemia is worst peripheral artery disease with high percent of morbidity and disability. Purpose of the study — to evaluate early (complications and major adverse events) and longterm (patency, limb salvage, survival) outcomes in patients with chronical limb threatening ischemia who underwent crossover autovenous bypass surgery. Material and method. A retrospective analysis of the early and long-term results of observation of 28 patients who underwent cross-bypass surgery performed in 2017–2023 was carried out. 100% of bypass operations were performed with autovenous material. High comorbidity (coronary artery disease, arterial hypertension, dyslipidemia, history of myocardial infarction, history of acute stroke, cardiac arrhythmias, diabetes mellitus, obstructive bronchitis, anemia, obesity). Follow-up is 12 months. Results. Early postoperative complications were: 14.3% — wound complications, 3.6% — bleeding, 7.2% — bypass thrombosis, 3.6% — acute cerebrovascular disturbance, 17.9% — high limb amputation (in 4 of 5 observations, revascularization was performed to reduce the level of amputation), 3.6% — death. Results after 12 months were: bypass patency — 82.1%, limb salvage — 71.4%, survival — 89.3%. There were no cases in which critical ischemia of the healthy lower limb developed. Conclusion. Crossover autovenous bypass can be considered by a vascular surgeon both as a reserve option for redo-surgery on the arteries of the lower extremities and as an alternative to traditional anatomical reconstructions. This study demonstrates the low complication rate and good long-term patency of this reconstructions.

References

Conte M.S., Bradbury A.W., Kolh P. et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69(6S):3S–125S.e40. DOI: 10.1016/j.jvs.2019.02.016.

Fitridge R., Chuter V., Mills J. et al. The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer. Diabetes Metab Res Rev. 2024;40(3):e3686. DOI: 10.1002/dmrr.3686.

Nordanstig J., Behrendt C.A., Baumgartner I. et al. Editor’s Choice — European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg. 2024;67(1):9–96. DOI: 10.1016/j.ejvs.2023.08.067.

Indes J.E., Pfaff M.J., Farrokhyar F. et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and metaanalysis. J Endovasc Ther. 2013;20:443–455. DOI: 10.1583/13-4242.1.

Chiu K.W., Davies R.S., Nightingale P.G., Bradbury A.W., Adam D.J. Review of direct anatomical open surgical management of atherosclerotic aorto-iliac occlusive disease. Eur J Vasc Endovasc Surg 2010;39:460–471. DOI: 10.1016/j.ejvs.2009.12.014.

Testini M., Todisco C., Greco L. et al. Femoro-femoral graft after unilateral obstruction of aorto-bifemoral bypass. Minerva Cardioangiol. 1998;46(1–2):15–19.

Ricco J.B., Probst H. Long-term results of a multicenter randomized study on direct versus crossover bypass for unilateral iliac artery occlusive disease. J Vasc Surg. 2008;47(1):45–53. DOI: 10.1016/j.jvs.2007.08.050.

Pai M., Handa A., Hands L., Collin J. Femoro-femoral arterial bypass is an effective and durable treatment for symptomatic unila­teral iliac artery occlusion. Ann R Coll Surg Engl. 2003;85(2):88–90. DOI: 10.1308/003588403321219830.

Capoccia L., Riambau V., da Rocha M. Is femorofemoral crossover bypass an option in claudication? Ann Vasc Surg. 2010;24(6):828–832. DOI: 10.1016/j.avsg.2010.03.021.

Kuchay A.A., Lipin A.N., Gruzdev N.N., Borisov A.G., Kashapov I.S. Critical limb threatening ischemia and its management. Russian Biomedical Research. 2024;9(1):33–46. DOI: 10.56871/RBR.2024.68.81.005. (In Russian).

Kuchay A.A., Lipin A.N. et al. The hybrid surgery concepts for athe­rosclerotic lesions of lower limb arteries. Atherosclersis and dysli­pidemias. 2023;3(52):37–43. (In Russian).

Kuchay A.A., Lipin A.N., Gruzdev N.N. et al. Lower extremity peripheral artery disease: contemporary epidemiology, management and future trends (a scientific statement). Russian Biomedical Research. 2023;8(4):54–64. (In Russian).

Kuchay A.A., Lipin A.N., Karelina N.R., Artyukh L.Yu. Revascularization of lower limb based on the angiosome concept with early local flap reconstruction (a case report). Forcipe. 2022;5(4):29–35. (In Russian).

Kuchay A.A., Lipin A.N., Karelina N.R. et al. Revascularization in extended occlusions of the superficial part of the femoral artery and multi-storey lesions of the arteries of the lower extremity. Forcipe. 2022;5(3):4–14. (In Russian).

Kurianov P., Lipin A., Antropov A. et al. Popliteal artery angioplasty for chronic total occlusions with versus without the distal landing zone. Annals of vascular surgery. 2020;62(68):417–25. (In Russian).

Kuchay A.A., Lipin A.N., Antropov A.V. et al. Treatment of multilevel lesions of arteries in lower extremities in cases of CLTI. Medical Alliance. 2022;10(S3):187–9. EDN: IWSMIP. (In Russian).

Published
2024-10-21
How to Cite
Borisov, A., Atmadzas, A., Gruzdev, N., Kozhevnikov, V., Kuchay, A., Lipin, A., Orlov, A., Pak, S., Sobolev, R., Eminov, Y., & Khokhlova, I. (2024). EXTRAANATOMIC CROSSOVER AUTOVENOUS BYPASS — RECONSTRUCTION OF THE RESERVE IN PATIENTS WITH A HIGH RISK OF AMPUTATION AND LOW LIFE EXPECTANCY OR AN ALTERNATIVE TO TRADITIONAL TREATMENT?. Russian Biomedical Research, 9(3), 15-20. https://doi.org/10.56871/RBR.2024.67.22.002
Issue
Vol 9 No 3 (2024)
Section
Статьи

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