gms | German Medical Science

10th Munich Vascular Conference

01.-03.12.2021, online

Anatomical reconstruction of the popliteal artery in critical lower limb ischemia

Meeting Abstract

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10th Munich Vascular Conference. sine loco [digital], 01.-03.12.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. Doc25

doi: 10.3205/21mac25, urn:nbn:de:0183-21mac255

Veröffentlicht: 22. Dezember 2021

© 2021 Chekhlov et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Relevance: Multilevel lesions of the distal femoral-popliteal arterial segment are difficult for revascularization due to the morphological features of the vascular system. Factors of an unfavorable long-term outcomes are:using stents in the flexible part of the artery, also using xenomaterial shunts to the distal part of the artery, as well as the conditions for excessive endothelialtrauma in the distal anastomosis (systemic arterial hypertension, absence of collateral decompression, extraanatomical anastomosis in the plane transverse to the blood flow).

Purpose: To study the effectiveness of various methods of anatomical reconstruction of long popliteal arterial occlusionsin the critical lower limb ischemia.

Materials and methods: In this study, we retrospectively compared the long-term results of popliteal artery revascularization in patients operated on for critical ischemia in the period from 2012 to 2020. To restore blood flow, various surgical and endovascular methods were used, including both vein (in situ – 38 persons, reversed –89 persons) and graft (23 persons) bypasses, open (44 persons) endarterectomies from the popliteal artery with the simultaneous angioplasty, as well as balloon angioplasty (21 persons) and stenting (17 persons) of affected areas.

The criteria that were also taken into account when assessing the effectiveness of the intervention included: preservation of the natural course of the vessel, visualization and preservation of collateral branches in the area of intervention, ease of еруaccess, its safety and maneuverability in the operating field, creation of a circular zone of intimal trauma in the area of the distal anastomosis as reocclusion factor, the length of the anastomosis as a factor in the duration of the surgeon's work and possible problems with surgical hemostasis.

Results: Xenomaterial shunts and stents of the middle and distal popliteal artery showed the worst results (no more than 6 months) in terms of magisterial blood flow functioning. Autologous shunting has conflicting results, depending on the hemodynamic conditions in the distal anastomosis, due to both the choice of the anastomosis site and the position of the shunt relative to the artery, and the patient's behavior in the postoperative period. The use of open or remote endarterectomy shows positive long-term results of maintaining the magisterial blood flow in the revascularized area. Balloon angioplasty performs its task of minimally invasive short-term relief of critical ischemia.

Conclusions: Anatomical methods of popliteal artery revascularization in the critical lower limb ischemia make it possible to create conditions for a longer limb revascularization with a number of advantages in access and damage control.