Retrograde Eversion Loop Endarterectomy for Chronic Atherosclerotic Occlusion of Superficial Femoral Artery
Introduction. In recent years, endarterectomy (EAE) has been increasingly used to restore blood circulation in the lower limbs in obliterating arterial diseases. However, the traditional method of loop EAE from the superficial femoral artery (SFA) with its chronic atherosclerotic occlusion has drawbacks that do not allow obtaining satisfactory results of the lower limb revascularization. Purpose. To compare the results of surgical treatment of patients with chronic lower limb ischemia due to atherosclerotic occlusion of the SFA using retrograde eversion loop (RELEAE) and traditional loop EAE. Materials and methods. A prospective comparative study included 148 male patients with different stages of chronic arterial insufficiency of the lower limb with atherosclerotic occlusion of the SFA. In the group I (n=75), revascularization of the lower extremity was carried out with traditional loop EAE, in the group II (n=73) - with the proposed retrograde eversion loop (RELEAE) method. The results were compared according to various criteria in the early postoperative period, as well as in 3, 6, 12, 24 and 36 months. Results. RELEAE showed preferable results in terms of invasiveness, duration of surgery and early postoperative period, frequency and severity of complications, mortality, primary patency, and primary level of limb preservation. Primary patency after RELEAE in 3 years was 71.2%, in the control group - 64.0%; the primary level of limb preservation - 90.4% and 84.0%; mortality - 4.1% and 8.0%, respectively (p<0.05). Conclusion. The advantages of revascularization of the lower extremity with the RELEAE method from SFA with its atherosclerotic occlusion over the traditional one are due to low invasiveness, the inclusion of second-order arteries in the circulation, formation of anastomosis, which reduces the progression of cicatricial and neointimal processes. The results of the study let to position REPEAE as the operation of choice in primary surgical intervention for SFA in its chronic atherosclerotic occlusion.