Endovascular treatment versus bypass in tasc II C&D SFA lesions : A non-randomized comparative study / by Khaled Tarek Fathy Abd Elmaksoud ; under the supervision of PROF. DR. Ahmed Abdel Hamid Taha, PROF. DR. Ahmed Gamal Eldien Fouad, ASSISTANT PROF. DR. Ahmed Mohsen Elmahrouky.

Thesis (Ph.D)-Cairo University, 2022.

Bibliography: pages 208-237.

the aim is to compare the outcome of endovascular interventions versus surgical bypass in treatment of superficial femoral artery atherosclerotic TASC II C&D lesions in patients with critical limb ischemia in terms of patency and limb salvage within one year follow up.
Patients and methods: our study included 41 patients in bypass group and 74 patients in endovascular group with atherosclerotic TASC II C&D SFA lesion. Patients with non-salvageable limbs, acute ischemia, trauma, aneurysms, connective tissue disorders and arteritis were excluded. All patients had Rutherford 3 to 6. Saphenous vein and synthetic grafts were used in bypass group. POBA, DCB and stents were used in endovascular group. The patients were followed up for 1 year.
Results: mean Patients’ age was 63.15 years in endo group and 58.76 in bypass group, male 78.4% in endo group and 85.4% in bypass group. Patients’ presentation was incapacitating claudications, rest pain, minor tissue loss, and major tissue loss. Technical success achieved in 100% in bypass cases and 95.9%in endo group. 1ry patency rate was 71.4% in the bypass group versus 57.6% in the endo group, still not significant statistically (p-value 0.0171). The assisted 1ry patency was 77.1% in bypass group and 83.3% in the endo group, the p.value was also not significant (0.449). 2ry patency rates was 82.9% and 89.4% in bypass and endo groups respectively. Also, the p.value was not significant (0.365). Our 1-year limb salvage rates were 85% in the bypass group versus 91.7%, the rate was better in the endo group but with statistically insignificant p.value between them (p: 0.343). The rate of reintervention was higher in endo group (31.8%) than bypass group (11.4%) which was statistically significant, (p.value 0.024). Overall mortality during follow up was only 1 patient in the bypass group (2.4%). the bypass group complications were much higher than those of the endo group (41.5% versus 12.2%) with statistically significant (p.value <0.001).
Conclusion: Bypass surgery and endovascular management have comparable short terms outcomes in terms of patency and limb salvage in treating long SFA atherosclerotic lesion TASC II C&D. Rate of reintervention is higher with endovascular strategy than bypass surgery. Bypass surgery has higher morbidity and mortality than endovascular treatment.

يعتبر القصور الحرج بالدوره الشريانيه الطرفيه مظهر من مظاهر تصلب الشرايين الطرفية الذى يصف المرضى الذين يعانون من الألم المزمن اثناء الراحة أو المرضى الذين يعانون من آفات الجلد ، إما قرحة أو الغرغرينا.
اهداف العلاج فتشمل استعادة التدفق النابض للدم فى القدم للمساعدة فى التئام الجروح، وتخفيف الألم ، وتجنب البتر فوق مستوى الكعب، والحفاظ على قدره المريض على التحرك، وتحسين الاداء الوظيفى للمريض وجوده الحياة.
على مدار العقد الماضي حدث تحول كبير فى تقنيات علاج مرضى القصور الحرج للدوره الدمويه الطرفيه وتمثل هذا التحول فى استخدام القسطره التداخليه (التوسيع البالونى ةاستخدام الدعامات) على نطاق اوسع على حساب التدخل الجراحى .حيث ان القسطره التداخليه تتمتع بنسبه مضاعفات ووفيات اقل من التدخل الجراحى مع الاحتفاظ بفاعليه مقاربه وتكلفه قد تكون اقل من التدخل الجراحي.
حيث ان معدل الوفاه فى مرضى القصور الحرج للدوره الدمويه الطرفيه يصل الى حوالي 25٪ من المرضى خلال العام الاول من تشخيص المرض وقد تصل هذه النسبه الى 32% خلال العام الثانى, فان اسلوب العلاج يختلف فى كل مريض على حده. وعلى الطبيب المعالج ان يكون على درايه بجميع خيارات العلاج وان يقوم بتحديد التدخل الأنسب أو مزيج من التدخلات، مع الأخذ بعين الاعتبار أهداف العلاج, النسبه بين الفائده والمخاطر، التواكب المرضي للمريض، ومتوسط العمر المتوقع.

Issues also as CD.

Text in English and abstract in Arabic & English.