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Superficial Femoral Artery Percutaneous Intervention To optimize Inflow For Distal Origin Bypass Grafts: An Effective Strategy?

Introduction and Objectives: Iliac angioplasty in preparation for an infrainguinal bypass graft has been shown to be an effective strategy. We undertook this study to determine if SFA angioplasty offers durable inflow for distal origin grafts (DOG) originating from the SFA or popliteal artery.
Methods: All DOGs performed between 1988 and 2006, within 30 days of an ipsilateral SFA percutaneous intervention, were reviewed retrospectively. Patients were identified from a computerized vascular registry and data was obtained by review of patient charts, angiograms, and duplex studies.
Results: 22 of the 23 autogenous DOG procedures performed below an SFA intervention were for critical limb ischemia (96%). The SFA lesions intervened upon (20 angioplasty alone, 3 angioplasty with stenting) included 11 TASC A(48%), 7 TASC B(30%), 5 TASC C(22%), and no TASC D(0%). Of the bypasses, 5 originated from the distal SFA, 5 originated from the above knee popliteal artery, and 13 originated from the below knee popliteal artery. A significant majority of the patients were diabetic (87%). No deaths, amputations, or early graft failures occurred during the perioperative period. The mean duration of follow-up was 32.2 months. By life-table analysis (Figure 1), the primary patency was 58% at both 1 and 2 years, and 48% at 5 years. The primary assisted patency was 69% at both 1 and 2 years, and 57% at 5 years. Of the 7 interventions required to maintain patency, only 1 targeted the SFA. None of the graft failures could be specifically attributed to disease progression of the SFA. The 5 year limb salvage and survival rates were 70% and 65%, respectively.
Conclusions: Percutaneous SFA intervention in preparation for a DOG is effective. The durability is excellent and this strategy provides a good option in the setting of both a diseased SFA and limited autogenous conduit.