The endovascular solutions for flush superficial femoral artery occlusion / Mohamed Ragab Saad Elnemr ; Supervised Ahmed Abdelhamid Taha , Hesham Mostafa Abdelsamad , Ahmed Sayed Mostafa

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of General Surgery

Chronic total occlusions of the femoropopliteal segments or infrapopliteal vessels are encountered more frequently with increasing patient longevity, bringing critical limb ischemia (CLI) to greater clinical attention. Endovascular therapy has been shown to be equivalent to surgical revascularization in achieving limb salvage with a favorable patient survival. Superficial femoral artery (SFA) chronic total occlusions (CTOs), especially in the ostial location, present the greatest operator challenge. Aim of the study: The aim of this study is to evaluate the different techniques of crossing the superficial femoral artery flush occlusion in patients with critical limb ischaemia regarding the feasibility, patency, clinical success, limb salvage rates and complications. Patients and Methods: This prospective study included 51 patients with flush SFA occlusion and critical L.L. ischemia for whom endovascular revascularization was done, between April 2013 and March 2014. Follow up was done at 3,6 and 12 months based on duplex examination and clinical assessment. Result: The Presentations were Gangrene (54.9%), ulcer (23.6%) and rest pain (21.6%). All cases were TASC D. Immediate success rate was 90.2%, patency rate was 100, 91.3, 71.7 % at 3,6 and 12 months. While limb salvage rate was 100, 93.47, 80.43 % at 3,6 and 12 months. Subintimal angioplasty (SIA) has higher patency and limb salvage rates 76.3% and 84.2% than PTA 50 % and 62.5%. no major complications occurred. Conclusion: Endovascular management is a good option for cases of flush SFA occlusion with the subintimal route recommended to be the route of choice

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