Indications and limitations of endovascular surgery in the infrageniculate district

Aims. A ret­ro­spec­tive anal­y­sis of the ­results of endo­vas­cu­lar ther­a­py in the treat­ment of pri­mary and post­op­er­a­tive ­lesions of the dis­tal arter­ies. Methods. The ­study includ­ed 55 ­patients under­go­ing endo­vas­cu­lar treat­ment of the infra­ge­nic­u­late pop­li­teal ­artery, the tibi­al arter­ies or pre­vi­ous femor­o­dis­tal bypass­es. The pop­u­la­tion was sub­di­vid­ed on the ­basis of the asso­ci­a­tion or oth­er­wise ­with revas­cu­lar­isa­tion sur­gery (28 (51.0%) vs 27 (49.0%)), or on the ­basis of ­redo sur­gery or pri­mary oper­a­tions (21 (38.1%) vs 34 (61.9%)). Results. Immediate tech­ni­cal suc­cess was ­achieved in 67.3% of cas­es ­with a paten­cy of 38.2% ­after 2 ­years. In ­terms of endo­vas­cu­lar pro­ce­dures ­alone, clin­i­cal suc­cess was ­achieved in 78.1% and 53.0% ­after 2 ­years. In endo­vas­cu­lar pro­ce­dures asso­ciat­ed ­with con­ven­tion­al sur­gery, imme­di­ate paten­cy was 62.5% (p<0.001) and 16.2% at 2 ­years (p<0.001). In pri­mary pro­ce­dures, imme­di­ate clin­i­cal suc­cess was ­obtained in 73.9% and 48.3% at 2 ­years. The imme­di­ate ­result of ­redo pro­ce­dures was 52.2% (p<0.001) and 19.2% at 2 ­years (p<0.001). Limb sal­vage in the ­event of ­redo sur­gery was ­achieved in 82.6% imme­di­ate­ly ­after sur­gery and 61.4% at 2 ­years, com­pared to 87.5% (n.s.) imme­di­ate­ly ­after sur­gery and 68.6% at 2 ­years (n.s.) in pri­mary sur­gery. Conclusions. Segmentary pri­mary ­lesions can be treat­ed ­with ­good ­results in ­terms of imme­di­ate and ­long-­term paten­cy, where­as in the ­case of asso­ciat­ed pro­ce­dures or ­redo sur­gery, the ­results are val­id if eval­u­at­ed in ­terms of ­limb sal­vage.