Immediate and late results of aorto-deep femoral artery bypass grafting

Introduction. The variability of the anatomical structure of the deep femoral artery is well known and described in many publications by Russian and foreign authors. Being a vessel with an extensive collateral ways, it becomes an excellent reservoir in case of bypass interventions on the aorto-femoral segment, and sometimes is an in-flow artery during reconstruction of the femoro-popliteal segment. Despite its good study, the question of the effectiveness of surgical interventions performed with a launch on the deep femoral artery with its magistral or scattered type of structure remains open.

The objective was to evaluate the results of open surgery – aorto-femoral bypass, with a launch on the deep femoral artery, taking into account the type of its anatomical structure.

Methods and materials. An analysis of the results of surgical treatment of 63 patients with the aorto-femoral segment occlusion, corresponding to type D, according to the TASC II classification, was carried out. All patients were divided into 2 groups depending on the type of structure of the deep femoral artery: I – magistral type; II – scattered type. The analysis included the results of the immediate and remote patency of the structure, the effectiveness of the interventions performed, patient survival, as well as the presence of factors that can directly or indirectly affect the course of the postoperative period.

Results. The immediate results of the interventions performed showed their effectiveness, manifested by an increase in the distance of pain-free walking, relief of pain, healing of trophic ulcers, regardless of the type of structure of the deep femoral artery (p<0.001). Five years after the operation, a greater number of thromboses of the aorto-femoral bypass graft was noted with a scattered type of artery structure (p=0.03). Factors that increase the risk of thrombosis in the late postoperative period were the scattered type of structure of the deep femoral artery and atrial fibrillation (p=0.04).

Conclusion. Aorto-femoral bypass grafting with initiation to the deep femoral artery is an effective treatment method regardless of the type of structure of the deep femoral artery, but late results show a significant advantage of the magistral type in terms of patency of the structure and maintaining quality of life.

1. Fowkes F. G., Rudan D., Rudan I. et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329– 40. https://doi.org/10.1016/S0140-6736(13)61249-0. PMID: 23915883.

2. Diseases G. B. D., Injuries C. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease study 2019. Lancet 2020;396:1204–22. https://doi.org/10.1016/S0140- 6736(20)30925-9.

3. Lin J., Chen Y., Jiang N. et al. Burden of peripheral artery disease an ditsattributable risk factors in 204 countries and territories from 1990 to 2019. Front Cardiovasc Med. 2022;9:868370. https://doi.org/10.3389/fcvm.2022.868370.

4. Norgren L., Hiatt W. R., Dormandy J. A. et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) Eur J Vasc Endovasc Surg. 2007;33(1 Suppl):S1–S75. https://doi.org/10.1016/j.ejvs.2006.09.024.

5. Miyahara T., Shigematsu K., Nishiyama A. et al. Long-term results of combined aortoiliac and infrainguinal arterial reconstruction for the treat ment of critical limb ischemia. Ann Vasc Dis. 2015;8(1):14–20. https://doi.org/10.3400/avd.oa.14-00119. PMID: 25848426; PMCID: PMC4369561.

6. National guidelines for the management of patients with lower limb artery diseases. Moscow. 2019; 89. (In Russ.).

7. Vakhitov K. M., Vakhitov M. Sh., Kuvazhukova A. F., Vladimirov P. A. Anatomical features of the profunda femoris artery as a factor in the degree of chronic limb ischemia. Regional blood circulation and microcirculation. 2024;23(3):50–56. (In Russ.). https://doi.org/10.24884/1682-6655-2024-23-3-50-56.

8. Manjappa T., Prasanna L. C. Anatomical variations of the profunda femoris artery and its branches-a cadaveric study in South Indian population. Indian J Surg. 2014;76(4):288–92. https://doi.org/10.1007/s12262-012-0677-3. PMID: 25278652; PMCID: PMC4175671.

9. Tzouma G., Kopanakis N. A., Tsakotos G. et al. Anatomic Variations of the Deep Femoral Artery and Its Branches: Clinical Implications on Anterolateral Thigh Harvesting. Cureus. 2020;12(4):e7867. https://doi.org/10.7759/cureus.7867. PMID: 32489722; PMCID: PMC7255544.

10. Kalinin R. E., Suchkov I. A., Klimentova É. A., Shanaev I. N. Clinical anatomy of deep femoral vessels in the area of femoral triangle. Angiol Sosud Khir. 2021;27(1):17–23. (In Russ.). https://doi.org/10.33529/ANGIO2021107. PMID: 33825724.

11. Rakhmatillaev T. B., Gusinskiy A. V., Shlomin V. V. et al. Long-term results of open aorto-femoral reconstructions. Grekov’s Bulletin of Surgery. 2021;180(1):54–59. (In Russ.) https://doi.org/10.24884/0042-4625-2021-180-1-54-59.

12. Hahtapornsawan S., Chaisongrit T., Chinchalongporn W. et al. Longterm clinical outcomes of arterial bypass and the factors independently associated with the primary patency in patients with suprainguinal arterial occlusion, Asian Journal of Surgery. 2024;47(Issue 10):4330–4335. https://doi.org/10.1016/j.asjsur.2024.04.092.

13. de Vries S. O., Hunink M. G. Results of aortic bifurcation grafts for aortoiliac occlusive disease: a meta-analysis. J Vasc Surg. 1997;26(4):558–69. https://doi.org/10.1016/s0741-5214(97)70053-3. PMID: 9357455.

14. Lee G. C., Yang S. S., Park K. M. et al. Ten year outcomes after bypass surgery in aortoiliac occlusive disease. J Korean Surg Soc. 2012;82(6):365–9. https://doi.org/10.4174/jkss.2012.82.6.365. PMID: 22708098; PMCID: PMC3373986.