Popliteal Endarterectomy as an alternative option to distal bypass in patients with localized infrageniculate popliteal occlusive disease and no autogenous conduit
Gulshan Sethi, Joseph Anain, Sr., Paul Anain.
Sisters of Charity Hospital of Catholic Health, Buffalo, NY, USA.
Popliteal Endarterectomy as an alternative option to distal bypass in patients with localized infrageniculate popliteal occlusive disease and no autogenous conduit.
Objective
Localized infrageniculate popliteal occlusive disease presents as a challenge to revascularization in patients with limited endovascular options and without an autogenous vein. Traditionally, in this group of patients it has been surgically bypassed with either a prosthetic graft or a prosthetic graft with a vein patch or cuff, or even a cryopreserved vein. These approaches have been limited, by their dismal patency rates, higher infection rates and lower limb salvage rates. We studied our patients retrospectively, who underwent infrageniculate popliteal and tibioperoneal endarterectomy, and present this as an attractive alternative option to distal bypass in patients with limited endovascular options and an absent autogenous vein conduit.
Methods
Our office based EMR, was used to review all patients who underwent infrageniculate popliteal and tibioperoneal endarterectomy between 2011-2015. Rutherford classification was used to assess clinical presentation of their peripheral arterial disease. Revised version of recommended standards for reports dealing with lower extremity ischemia; by Rutherford (1997); was used as a measure of revascularization outcome.
Results
A total of 27 patients from 2011-2015 were studied. 3 patients were lost to follow up, and were excluded from the study. Median age was 72 yrs. 16 of them were males, 11 were females. All patients had chronic Critical limb ischemia, defined by Classes IV, V and VI by Rutherford Classification. Revascularization outcomes were measured as per Rutherford (1997) scale. 8 patients were given a grade of +3; 6 patients were given a grade of +2; 3 patients were given a grade +1; 3 patients were graded at -1, 1 patient had -2, 3 patients had -3 with unexpected major amputations. Our revascularization outcomes, and limb salvage rates are compared to autogenous vein conduits at 87%, better than those reported for non-autogenous conduits.
Conclusion
Infrageniculate Popliteal endarterectomy for localized chronic occlusive popliteal disease is an attractive alternative option to distal bypass in patients with limited endovascular options and with no autogenous conduit. It has higher limb salvage rates, and better revascularization outcomes as compared to non-autogenous conduits.
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