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CardioVascular and Interventional Radiology

, Volume 42, Issue 9, pp 1279–1292 | Cite as

Endovascular Extra-Anatomic Femoro-Popliteal Bypass for Limb Salvage in Chronic Critical Limb Ischemia

  • M. Di PrimioEmail author
  • G. Angelopoulos
  • I. Lazareth
  • F. Lin
  • A. Petit
  • P. Priollet
  • M. Sapoval
  • J. Emmerich
  • A. Yannoutsos
Article
Part of the following topical collections:
  1. Arterial Interventions

Abstract

Purpose

To report the initial clinical experience with fully endovascular extra-anatomic femoro-popliteal bypass (FPB) for limb salvage in patients with critical limb ischemia (CLI) and no traditional endovascular or surgical revascularization options.

Methods

Between June 2013 and May 2018, endovascular procedure was proposed for limb salvage during multidisciplinary team meeting in fifteen hospitalized patients (median age 67 years; 73% men) with CLI and a high risk of major amputation. Primary outcome was amputation-free survival at 1 year. Secondary outcomes included mortality, cardiovascular (CV) events and major limb amputation at 1 year, primary/secondary bypass patency and wound healing at the last follow-up visit. Procedure-related complications (deaths, CV events, hemorrhages) were recorded through 30 days.

Results

Technical procedure success rate was 100%. Major peri-procedural outcomes occurred in two patients (13%): One patient died secondary to cardiogenic shock; one patient suffered acute coronary syndrome associated with iliopsoas bleeding. No major amputation occurred through 30 days. Median follow-up period was 21.5 (18.25–45.5) months (last follow-up visits on April 2019). Amputation-free survival at 1-year and at the last follow-up visit was 80% and 53%, respectively. Cumulative mortality at 1-year and at the last follow-up visit was 13% and 33%, respectively. Primary and secondary bypass patency was 27% and 60%, respectively. Complete wound healing was achieved in 11 patients (73%).

Conclusion

Endovascular extra-anatomic FPB represents an innovative approach for limb salvage in CLI with no traditional endovascular or surgical revascularization options. Our clinical experience highlights that this technique remains challenging because of frequent comorbidities and fragility of this patient population.

Level of Evidence

Level 4, Case series.

Keywords

Critical limb ischemia Endovascular revascularization Femoro-popliteal bypass Limb salvage 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Consent for Publication

Consent for publication was obtained for every individual person’s data included in the study.

Disclosures

The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of this paper and its final contents.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Interventional Radiology DepartmentGroupe Hospitalier Paris Saint-JosephParisFrance
  2. 2.Interventional RadiologyHôpital Privé de Parly 2Le ChesnayFrance
  3. 3.Vascular Medicine DepartmentGroupe Hospitalier Paris Saint-JosephParisFrance
  4. 4.Medical Information DepartmentGroupe Hospitalier Paris Saint-JosephParisFrance
  5. 5.Interventional Radiology DepartmentHôpital Européen Georges PompidouParisFrance
  6. 6.Université Paris Descartes, Sorbonne Paris CitéParisFrance
  7. 7.INSERM U970ParisFrance
  8. 8.INSERM UMR 1153-CRESSParisFrance

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