MODERN CONCEPT AND REVASCULARIZATION OF EXTENDED OCCLUSION OF THE SUPERFICIAL FEMORAL ARTERY ACCOMPANIED BY MULTILEVEL OCCLUSIONS OF THE LOWER EXTREMITIES IN CHRONIC LIMB THREATENING ISCHEMIA

Kuchay Arshed A., Lipin Alexander N.

The revascularization of chronic total occlusion (CTO) in patients with prolonged occlusion of superficial femoral artery (SFA) >20 cm with compound tibial runoff remains a significant challenge and it’s is a complex concern with multiple treatment techniques and strategies. More than 66% of patients with chronic limb threatening ischemia (CLTI) exist with SFA disorder, often with unobstructed proximal popliteal artery and immense occlusive lesions in the tibial vessels. This article will cover techniques for hybrid interventions to treat SFA CTO with compound tibial runoff in patients with CLTI. Aim: To improve the results of revascularization, develop conception and hybrid algorithm to approach complex superficial femoral artery (SFA) chronic total occlusions (CTOs) in combination with tibial runoff. Conclusions: The results of our study shows that the femoral tibial bypass as compared to a hybrid intervention comprised of a bypass to a unobstructed popliteal artery and subsequent tibial angioplasty decreased the early failure rate without any negative effect on the long-term outcomes in CLTI patients with prolonged SFA CTO and immense runoff disease.

Keywords:chronic total occlusion, multilevel lesions, hybrid operation, endovascular intervention, chronic limb threatening ischemia, long occlusion