Endovascular Therapy For Long Segmental Atherosclerotic Occlusive Disease Of The Lower Limbs

Objective The aim of the present study was to explore endovascular therapy forlong segmental atherosclerotic occlusive disease of the lower limbs with Trans-AtlanticCollaboration II (TASC II) C、D, and evaluate the feasibility and the early clinicaleffects of angioplasty plus stent implantation in the treatment of the long lowerextremity arterial occlusion. This technique will expand the indications of endovasculartreatment, and change the quality of life of patients with long segment occlusion in thelower limbs.Methods From January2009to December2011,32cases (34limbs) with longsegmental atherosclerotic occlusive disease of lower limb of TASCⅡC、D wereretrospectively analyzed,6cases of iliac occlusive TASC Ⅱ C grade lesions wereperformed contralateral approach ("overfly" technology) in Seldinger technique underlocal anesthesia,3cases of iliac occlusive TASC Ⅱ C grade lesions and3cases ofpatients with iliac occlusive TASC Ⅱ D grade lesions were performed retrogradebilateral femoral artery puncture with subintimal arterial flossing withantegradeRetrograde interventional technology,12cases of femoropopliteal occlusiveTASC Ⅱ C grade lesions and5cases of of TASC Ⅱ D fgrade lesions were performedarterial thrombolysis with percutanious transluminal angioplasty(PTA) and stenting,2cases of femoropopliteal occlusive TASC ⅡC grade lesions were performed subintimalangioplasty under ultrasound guiding,1cases of femoropopliteal occlusive TASC ⅡCgrade lesions were performed subintimal arterial flossing with ategraderetrograde intervention. Each patient received clinical and ultrasound/computerized tomographicangiography evaluations preoperative and postoperative.Results Twenty nine limbs were revascularization successfully. PTA was performedin5limbs. PTA with stent placememt was performed in24limbs. Twenty fourself—expanding Nitinol stents were deployed．The procedure were turned to bypassoperation in4limbs，1limbs were amputated above knee．The technical success ratewas85.3%（29/34）. Mean follow-up period for27limbs from29patients was12months (range,3-18). During follow-up. three to eighteen months(mean12months)follow-up was performed in29cases93.1％(27／29). The mean ABI increased from0.39±0.14to0.86±0.19in dorsalis pedis artery (P<0.01). and the ABI increased from0.45±0.12to0.90±0.10in posterior tibial artery (P<0.01). At6months, the patencyrates were88.9％(24／27). The limb salvage rates were96.3％(26／27). At12monthspatency rates were77.8％(21／27).The limb salvage rates were88.9％(24／27).Conclusions For long segmental atherosclerotic occlusive disease of the lower limbs,endovascular therapy is minimal invasion，safe，and has an ideal short term effect.Because of the complexity of the lower extremity arterial disease, different proceduresrequire in combination with each other, which will reduce the difficulty, complexity andpostoperative complications of the surgery. Endovascular therapy seems to be a goodchoice for patients with long segmental atherosclerotic occlusive disease of the lowerlimbs at high risk of surgical tolerance. Although the short-term patency results weregood, more observations are needed to assess its long-term efficiency.