Therapy Analysis of 122 Occlusive Superficial Femoral Artery Diseases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIDa-lin ,  ZHANGKun , YANJing-qiang , CHENYun-hui

Department of Vascular Surgery, Qingdao Municipal Hospital, Qingdao 266071, Shandong Province, China;

Corresponding?author：

ZHANGKun, Email: zksw0711@126.com

Keywords：

Superficial femoral artery; Percutaneous transluminal angioplasty; Stent; Artery artificial graft bypass

DOI：

10.7507/1007-9424.20150061

Video：

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Objective To summarize the effects of endovascular intervention and artificial graft bypass for the occlusive superficial femoral artery disease. Methods The clinical data of 122 patients (136 limbs) with superficial artery occlusive disease underwent endovascular intervention or artificial graft bypass from January 2008 to April 2011 in this hospital were collected retrospectively. Age, TASCⅡgrading, condition of outflow tract, complications before and after procedures, hospital stay, primary patency rate, rate of amputation, and death rate were recorded. Results ①Seventy-four limbs of 64 patients were accepted percutaneous transluminal angioplasty and stent graft (PTA/S group), 62 limbs of 58 patients were accepted femoral popliteal artery artificial graft bypass (artificial graft bypass group). Compared with the artificial graft bypass group, the age was significantly older (P < 0.05), TASCⅡA or B lesions were more (P < 0.05), TASCⅡC or D lesions were less (P < 0.05), the limbs with one or three outflow tracts were more (P < 0.05) in the PTA/S group. The limbs with two outflow tracts, and the patients combined with diabetes or hypertension or diabetes and hypertension had no significant differences between these two groups (P > 0.05).②There was no perioperative mortality in two groups. Compared with the artificial graft bypass group, the average hospital stay was sifnificantly shorter (P < 0.05), the 3-year death rate after procedure was higher (P < 0.05), the rate of postoperative incision infection was lower (P < 0.05), the primary patency rate of 36-month after operation was lower (P < 0.05) in the PTA/S group. The rate of amputation, the primary patency rates of 6-, 12-, and 24-month after operation had no significant differences between these two groups (P > 0.05). Conclusions Management of occlusive superficial femoral artery disease with femoral popliteal artery artificial bypass grafting exhibits a higher long term patency as compared with percutaneous stent graft. However, the hospital stay is longer than that in PTA/S group, and postoperative infection also occurres individually in artificial graft bypass group. Percutaneous transluminal angioplasty and stent graft has little trauma, faster recovery, shorter hospital stay, which is an important significance for the patients with too old or weak to accept femoral popliteal artery artificial graft bypass. But its long term patency rate needs to be improved.

Citation： LIDa-lin, ZHANGKun, YANJing-qiang, CHENYun-hui. Therapy Analysis of 122 Occlusive Superficial Femoral Artery Diseases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(2): 230-234. doi: 10.7507/1007-9424.20150061 Copy

1.	Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg, 2007: S5-S67.
2.	Siracuse JJ, Giles KA, Pomposelli FB, et al. Results for primary bypass versus primary angioplasty/stent for intermittent claudication due to superficial femoral artery occlusive disease. J Vasc Surg, 2012, 55(4): 1001-1007.
3.	Poncyljusz W, Falkowski A, Safranow K, et al. Cutting-balloon angioplasty versus balloon angioplasty as treatment for short atherosclerotic lesions in the superficial femoral artery: randomized controlled trial. Cardiovasc Intervent Radiol, 2013, 36(6): 1500-1507.
4.	Delaney CL, Miller MD, Chataway TK, et al. A randomised controlled trial of supervised exercise regimens and their impact on walking performance, skeletal muscle mass and calpain activity in patients with intermittent claudication. Eur J Vasc Endovasc Surg, 2014, 47(3): 304-310.
5.	Farkas K, Járai Z, Kolossváry E, et al. High prevalence of peripheral arterial disease in hypertensive patients: the Evaluation of Ankle-Brachial Index in Hungarian Hypertensives screening program. J Hypertens, 2012, 30(8): 1526-1532.
6.	Ihnat DM, Duong ST, Taylor ZC, et al. Contemporary outcomes after superficial femoral artery angioplasty and stenting: the influence of TASC classification and runoff score. J Vasc Surg, 2008, 47(5): 967-974.
7.	Nicolai SP, Hendriks EJ, Prins MH, et al. Optimizing supervised exercise therapy for patients with intermittent claudication. J Vasc Surg, 2010, 52(5): 1226-1233.
8.	黃新天, 蔣米爾, 陸民, 等. PTA及血管內支架在治療下肢動脈硬化閉塞癥的應用價值.中國實用外科雜志, 2000, 20(6): 347-348.
9.	李京雨, 劉濤, 路軍良, 等.介入治療復雜下肢動脈硬化閉塞癥技術與療效分析.中華放射學雜志, 2011, 45(10): 960-963.
10.	師天雄, 繆健航, 胡錫祥.下肢動脈硬化性閉塞癥的介入治療體會.中國普外基礎與臨床雜志, 2010, 17(7): 676-678.
11.	馬震寰, 楊鏞, 楊國凱, 等.下肢動脈硬化閉塞癥繼發血栓形成治療分析.中國普外基礎與臨床雜志, 2010, 17(3): 275-277.
12.	Norgren L, Hiatt WR, Dormandy JA, et al. The next 10 years in the management of peripheral artery disease: perspectives from the 'PAD 2009' Conference. Eur J Vasc Endovasc Surg, 2010, 40(3): 375-380.
13.	Rabellino M, Zander T, Baldi S, et al. Clinical follow-up in endovascular treatment for TASC C-D lesions in femoro-popliteal segment. Catheter Cardiovasc Interv, 2009, 73(5): 701-705.
14.	Baril DT, Chaer RA, Rhee RY, et al. Endovascular interventions for TASC II D femoropopliteal lesions. J Vasc Surg, 2010, 51(6): 1406-1412.
15.	管圣.長段股腘動脈硬化閉塞的腔內治療.國際外科學雜志, 2009, 36(8): 516-518.
16.	Dósa E, Nemes B, Bérczi V, et al. High frequency of brachiocephalic trunk stent fractures does not impair clinical outcome. J Vasc Surg, 2014, 9(3): 781-785.
17.	Neil N. Stent fracture in the superficial femoral and proximal popliteal arteries: literature summary and economic impacts. Perspect Vasc Surg Endovasc Ther, 2013, 25(1/2): 20-27.
18.	Dys K, Drelichowska-Durawa J, Do?ega-Kozierowski B, et al. Mechanical thrombectomy using rotarex system and stent-in-stent placement for treatment of distal femoral artery occlusion secondary to stent fracture－a case report and literature review. Pol J Radiol, 2013, 78(3): 74-79.
19.	Kralj I, Boos I, Mueller-Buehl U. Three year results of endovascular therapy with a new generation nitinol stent for femoro-popliteal artery lesions－a single-center outcome analysis of a subcohort of MISAGO 2 study. Vasa, 2013, 42(5): 340-349.
20.	Davaine JM, Querat J, Guyomarch B, et al. Incidence and the clinical impact of stent fractures after primary stenting for TASC C and D femoropopliteal lesions at 1 year. Eur J Vasc Endovasc Surg, 2013, 46(2): 201-212.
21.	Park YM, Ahn T, Lee K, et al. A comparison of two brands of clopidogrel in patients with drug-eluting stent implantation. Korean Circ J, 2012, 42(7): 458-463.
22.	Schnorbus B, Daiber A, Jurk K, et al. Effects of clopidogrel, prasugrel and ticagrelor on endothelial function, inflammatory and oxidative stress parameters and platelet function in patients undergoing coronary artery stenting for an acute coronary syndrome. A randomised, prospective, controlled study. BMJ Open, 2014, 4(5): e005268.
23.	Guo BL, Tan QW, Guo DQ, et al. Patients carrying CYP2C19 loss of function alleles have a reduced response to clopidogrel therapy and a greater risk of in-stent restenosis after endovascular treatment of lower extremity peripheral arterial disease. J Vasc Surg, 2014, 60(4): 993-1001.
24.	Aihara H, Soga Y, Mii S, et al. Comparison of long-term outcome after endovascular therapy versus bypass surgery in claudication patients with Trans-Atlantic Inter-Society Consensus-ⅡC and D femoropopliteal disease. Circ J, 2014, 78(2): 457-464.
25.	Ichihashi S, Higashiura W, Itoh H, et al. Long-term outcomes for systematic primary stent placement in complex iliac artery occlusive disease classified according to Trans-Atlantic Inter-Society Consensus (TASC)-Ⅱ. J Vasc Surg, 2011, 53(4): 992-999.

1. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg, 2007: S5-S67.
2. Siracuse JJ, Giles KA, Pomposelli FB, et al. Results for primary bypass versus primary angioplasty/stent for intermittent claudication due to superficial femoral artery occlusive disease. J Vasc Surg, 2012, 55(4): 1001-1007.
3. Poncyljusz W, Falkowski A, Safranow K, et al. Cutting-balloon angioplasty versus balloon angioplasty as treatment for short atherosclerotic lesions in the superficial femoral artery: randomized controlled trial. Cardiovasc Intervent Radiol, 2013, 36(6): 1500-1507.
4. Delaney CL, Miller MD, Chataway TK, et al. A randomised controlled trial of supervised exercise regimens and their impact on walking performance, skeletal muscle mass and calpain activity in patients with intermittent claudication. Eur J Vasc Endovasc Surg, 2014, 47(3): 304-310.
5. Farkas K, Járai Z, Kolossváry E, et al. High prevalence of peripheral arterial disease in hypertensive patients: the Evaluation of Ankle-Brachial Index in Hungarian Hypertensives screening program. J Hypertens, 2012, 30(8): 1526-1532.
6. Ihnat DM, Duong ST, Taylor ZC, et al. Contemporary outcomes after superficial femoral artery angioplasty and stenting: the influence of TASC classification and runoff score. J Vasc Surg, 2008, 47(5): 967-974.
7. Nicolai SP, Hendriks EJ, Prins MH, et al. Optimizing supervised exercise therapy for patients with intermittent claudication. J Vasc Surg, 2010, 52(5): 1226-1233.
8. 黃新天, 蔣米爾, 陸民, 等. PTA及血管內支架在治療下肢動脈硬化閉塞癥的應用價值.中國實用外科雜志, 2000, 20(6): 347-348.
9. 李京雨, 劉濤, 路軍良, 等.介入治療復雜下肢動脈硬化閉塞癥技術與療效分析.中華放射學雜志, 2011, 45(10): 960-963.
10. 師天雄, 繆健航, 胡錫祥.下肢動脈硬化性閉塞癥的介入治療體會.中國普外基礎與臨床雜志, 2010, 17(7): 676-678.
11. 馬震寰, 楊鏞, 楊國凱, 等.下肢動脈硬化閉塞癥繼發血栓形成治療分析.中國普外基礎與臨床雜志, 2010, 17(3): 275-277.
12. Norgren L, Hiatt WR, Dormandy JA, et al. The next 10 years in the management of peripheral artery disease: perspectives from the 'PAD 2009' Conference. Eur J Vasc Endovasc Surg, 2010, 40(3): 375-380.
13. Rabellino M, Zander T, Baldi S, et al. Clinical follow-up in endovascular treatment for TASC C-D lesions in femoro-popliteal segment. Catheter Cardiovasc Interv, 2009, 73(5): 701-705.
14. Baril DT, Chaer RA, Rhee RY, et al. Endovascular interventions for TASC II D femoropopliteal lesions. J Vasc Surg, 2010, 51(6): 1406-1412.
15. 管圣.長段股腘動脈硬化閉塞的腔內治療.國際外科學雜志, 2009, 36(8): 516-518.
16. Dósa E, Nemes B, Bérczi V, et al. High frequency of brachiocephalic trunk stent fractures does not impair clinical outcome. J Vasc Surg, 2014, 9(3): 781-785.
17. Neil N. Stent fracture in the superficial femoral and proximal popliteal arteries: literature summary and economic impacts. Perspect Vasc Surg Endovasc Ther, 2013, 25(1/2): 20-27.
18. Dys K, Drelichowska-Durawa J, Do?ega-Kozierowski B, et al. Mechanical thrombectomy using rotarex system and stent-in-stent placement for treatment of distal femoral artery occlusion secondary to stent fracture－a case report and literature review. Pol J Radiol, 2013, 78(3): 74-79.
19. Kralj I, Boos I, Mueller-Buehl U. Three year results of endovascular therapy with a new generation nitinol stent for femoro-popliteal artery lesions－a single-center outcome analysis of a subcohort of MISAGO 2 study. Vasa, 2013, 42(5): 340-349.
20. Davaine JM, Querat J, Guyomarch B, et al. Incidence and the clinical impact of stent fractures after primary stenting for TASC C and D femoropopliteal lesions at 1 year. Eur J Vasc Endovasc Surg, 2013, 46(2): 201-212.
21. Park YM, Ahn T, Lee K, et al. A comparison of two brands of clopidogrel in patients with drug-eluting stent implantation. Korean Circ J, 2012, 42(7): 458-463.
22. Schnorbus B, Daiber A, Jurk K, et al. Effects of clopidogrel, prasugrel and ticagrelor on endothelial function, inflammatory and oxidative stress parameters and platelet function in patients undergoing coronary artery stenting for an acute coronary syndrome. A randomised, prospective, controlled study. BMJ Open, 2014, 4(5): e005268.
23. Guo BL, Tan QW, Guo DQ, et al. Patients carrying CYP2C19 loss of function alleles have a reduced response to clopidogrel therapy and a greater risk of in-stent restenosis after endovascular treatment of lower extremity peripheral arterial disease. J Vasc Surg, 2014, 60(4): 993-1001.
24. Aihara H, Soga Y, Mii S, et al. Comparison of long-term outcome after endovascular therapy versus bypass surgery in claudication patients with Trans-Atlantic Inter-Society Consensus-ⅡC and D femoropopliteal disease. Circ J, 2014, 78(2): 457-464.
25. Ichihashi S, Higashiura W, Itoh H, et al. Long-term outcomes for systematic primary stent placement in complex iliac artery occlusive disease classified according to Trans-Atlantic Inter-Society Consensus (TASC)-Ⅱ. J Vasc Surg, 2011, 53(4): 992-999.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Therapy Analysis of 122 Occlusive Superficial Femoral Artery Diseases

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