ENDOVASCULAR CORRECTION OF FEMORO-POPLITEAL LESIONS: FACTORS OF SUCCESS AND FAILURE

V.V. Demin, V.V. Zeienm, A.N. Zheludkov, V.N. Skovorodnikov, A.G. Degtiarev

The paper presents analysis of early and long-term outcome of 89 radiosurgical procedures on femoro-popliteal arterial segment, carried out in 73 patients from 1996 to 1999. More then one third of the group had III-lV ischemic grade, occlusion of 2 or 3 tibial arteries was revealed in 45% of patients, occlusion of popliteal artery – in 11%. 33.7% of patients suffered from total arterial occlusion extending up to 25 cm. Besides digital angiography patients underwent endovascular sonography both pre- and intraoperatively. In 9% of cases intravascular stents were implanted. Along with hydrophilic and supporting guides, rotor-plasty was used for arterial recanalization. In 12 cases (13.4%) initial and intraoperative thrombi were removed by transcutaneous rheolytic thrombectomy with the use of AngioJet соmрlex. Twenty five patients underwent combined endovascular and surgical interventions. Good and satisfactory early results were obtained in 92% (for patients with 11 B grade – in 95%). Follow-up examinations in the period from 3 months to 1 year and later showed maintenance of positive surgical effect in 87.5-94% of cases. Factors predicting successful outcome were: modern preoperative and intraoperative diagnostic modalities (including endovascular ultrasonic scanning) enabling to determine intervention strategy and obtain safe outcome control; optimal choice of instrumentation minimizing its exchange during procedure and shortening the time of operation; stent implantation of various size and design; use of modern mechanic devices for recanalization and plaque extraction; rheolytic thrombectomy for removal of nonorganized thrombi, especially for prevention of intraoperative thromboembolic complications; combination of endovascular and surgical methods; outpatient follow-up with scheduled angiography 3-4 months since operation and staged strategy of management in some cases.

KEY WORDS: balloon angioplasty, rotor recanalization, endovascular ultrasonic scanning, rheolytic thrombectomy.

P. 63-64

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