Bypass first for femoral-popliteal-tibial arterial lesions in patients with CLI in the era of endovascular surgery

BACKGROUND. Most patients with critical limb ischemia (CLI) have multi-stage atherosclerotic femoral-popliteal-tibial arterial lesions. The optimal choice of revascularization method in this cohort of patients remains an unresolved issue. AIM: to evaluate the effectiveness of primary tibial vein bypass for lesions of the femoral-popliteal-tibial arterial segment in patients with CLI in the era of endovascular surgery. METHODS. The results of 112 primary tibial vein bypass performed between 2010 and 2021 were analyzed. Chronic arterial insufficiency of the lower extremities was stage 3 in 25 patients (22.3%) and stage 4 in 87 patients (77.7%) according to the Fontaine-Pokrovsky classification. The distribution of patients by atherosclerotic lesions of the arteries of the lower extremities according to the TASC II classification was as follows: type C - 9 people (8.0%), type D – 103 people (92.0%). RESULTS. Within 30 days, adverse cardiovascular events were detected in 4 patients (3.6%), early major amputation was performed in 3 patients (2.7%). Perioperative mortality was 2.7% (3 patients). Primary patency of tibial vein bypass was 91%, 76% and 67% after 1, 3 and 5 years, respectively, while secondary patency was 93%, 80% and 71% after 1, 3 and 5 years, respectively. The limb salvage rate was 98%, 86% and 81.5% after 1, 3 and 5 years, respectively. Overall patient survival was 88.5%, 81% and 70% after 1, 3 and 5 years, respectively. CONCLUSION. Primary tibial vein bypass are an effective and safe method of surgical treatment of atherosclerotic lesions of the femoral-popliteal-tibial arterial segment in patients with critical limb ischemia. Open surgeries can be used as first-line operations in the era of endovascular surgery with comparable immediate and remote results.