Primary femoro-popliteal-tibiofibular bypass in patients with critical limb ischemia in the era of endovascular surgery

BACKGROUND: In the majority of patients with critical ischemia in the lower limbs, the findings include the «multi-level» atherosclerotic lesions in the arteries of the femoral-popliteal-tibiofibular segment. The optimal method of re-vascularisation in this cohort of patients is not defined as of today. AIM: To evaluate the efficiency of conducting the initial autovenous tibiofibular bypass surgery in case of lesions in the arteries of the femoral-popliteal-tibiofibular segment in patients with critical ischemia of the lower limbs. METHODS: The analysis included the results of the initial tibiofibular autovenous bypass surgeries, performed in 112 patients at the Federal State Budgetary Institution «Federal Clinical Center of High Medical Technologies» under the Russian Federal Medical-Biological Agency during the period from 2010 until 2021, of which 25 (22.3%) individuals had the stage III chronic arterial insufficiency in the lower limbs, 87 (77.7%) — stage IV acc. to the Fountain–Pokrovsky classification. The distribution by the atherosclerotic lesion in arteries of the lower limbs with taking into consideration the TASC II classification was the following: type C — in 9 (8.0%), type D — in 103 (92.0%). RESULTS: Within the 30 days period, 4 (3.6%) patients have shown the presence of unfavorable cardio-vascular events, 3 (2.7%) cases resulted in the early high amputation. The perioperative mortality rate was 2.7% (n=3). The primary passability of the tibiofibular autovenous bypass was 91%, 76% and 67% in 1, 3 and 5 years, while the secondary passability was 93%, 80% and 71%; the limb survival rate was 98%, 86% and 81,5%; the overall survival of the patients was 88.5%, 81% and 70%, respectively. CONCLUSION: The initial tibiofibular autovenous bypass surgeries (bypass first) represent the effective and safe method of surgical treatment for atherosclerotic lesions in the arteries of the femoral-popliteal-tibiofibular segment in patients with critical ischemia of the lower limbs. Open-access surgeries in the era of endovascular surgery can be used as the first line therapy with comparable direct and remote results.