RESUMO
Surgical bypass is the gold standard treatment in patients affected by chronic limb-threatening ischemia in advanced GLASS stages, according to the Global Vascular Guidelines. For patients in whom an autologous graft is not available, a prosthesis could be used with the adjunct of a distal arteriovenous fistula interposition. The aim of this study was to examine the long-term results of below-the-knee surgical revascularization using a prosthesis with the distal adjunct mentioned above. From 2010 to 2020, we performed 159 lower limb below-the-knee surgical revascularizations using a prosthesis with the creation of an arteriovenous fistula interposition on the distal anastomosis. The GLASS stage was 3 in 100% of patients. The primary patency rates were as follows: 86.7% at 1 year, 57.2% at 3 years, and 12.6% at 5 years. The graft thrombosis rates were 17.4% at 1 year, 42.1% at 3 years, and 64.5% at 5 years. The amputation-free survival rates were 79% at 1 year, 76% at 3 years, and 64% at 5 years. PTFE prosthetic bypass for below-the-knee arteries using an arteriovenous fistula interposition is a good solution in patients without an autologous conduit. This technique offers reasonable graft patency and limb salvage rates.
RESUMO
BACKGROUND: The aim of this study was to find out if intra-arterial intraoperative iloprost administration, in selected patients undergoing endovascular revascularization procedures, could lead to better results compared with a control group of patients with similar clinical background and risk factors. METHODS: We prospectively collected data of consecutive patients undergoing endovascular or hybrid revascularization in the period from June 2017 to August 2019, which were then retrospectively analyzed. Those patients were divided into 2 groups: iloprost and control groups. Inclusion criteria were as follows: the presence of an arteriography that included the foot; Rutherford class 4-6; and Rutherford class 3 with at least 2 cardiovascular risk factors or previous revascularization procedures on the same limb. The intraoperative intra-arterial administration of iloprost was the inclusion criterion for the iloprost group. Patients with a compromised cardiological condition were excluded, as this was a contraindication for iloprost administration. Patients from the 2 groups were matched using the propensity score matching (PSM) methodology of Rosenbaum and Rubin. The primary outcome was freedom from target lesion revascularization (TLR). The secondary outcomes were limb salvage and overall survival. RESULTS: During the mentioned period, we treated 190 consecutive limbs. The mean follow-up was 11.73 months (median, 10; interquartile range, 5-19). After PSM, the freedom from TLR was significantly better in the iloprost group (78 ± 7%, 74 ± 8%, and 63 ± 9% vs. 67 ± 8%, 50 ± 9%, and 38 ± 10% at 3, 6, and 12 months, respectively; P = 0.043). No significant difference was found in terms of limb salvage (92 ± 5%, 88 ± 6%, and 88 ± 6% vs. 92 ± 4%, 85 ± 6%, and 81 ± 7% at 3, 6, and 12 months, respectively; P = 0.52) and survival (95 ± 3%, 95 ± 3%, and 95 ± 3% vs. 95 ± 4%, 92 ± 5%, and 71 ± 9% at 3, 6, and 12 months, respectively; P = 0.14) between the 2 groups. CONCLUSIONS: These results seem to encourage considering intraoperative use of this adjunct, at least in endovascular revascularization procedures, to improve distal outflow.
