Early results of surgical and Endovascular intervention procedures in Lower extremity arterial disease
Authors: Chandrakumar Sistla VPL , Padhy Ajit Kumar , Guroo sartaj , Popli Khuswant , Kumar Madhur , Garg Puneet , Gupta Anubhav 
Published: June 2021

Objective : To assess the early results of surgical and
endovascular intervention in peripheral arterial disease
Materials and methods : Retrospectively, we analysed the early
results of treatment of lower extremity arterial diseases,
managed at our institute. Depending up on the lesion
characters and the distal run-off as evident from imaging,
patients underwent either surgical or endovascular
intervention for their disease. Over a period of one-year form
July 2018 to July 2019, twenty-two patients were managed in
total. Nine of them underwent surgical bypass for either aortoiliac or femoro-popliteal lesions. Another thirteen patients
underwent endovascular intervention for lesions at aorto-iliac,
femoro-popliteal and “Below the Knee” lesions. Procedure
related morbidity, procedural success rate, postoperative pain
score, hospital stay, flow patency and symptomatic
improvement at follow-up at three and six months were
analysed.
Results:
The results were optimistic with ischemic ulcers showing signs
of healing, patients symptomatically better with improved
walking distance and relieved of rest pain. Due to a smaller
study population, limited study time and the study itself being
a non- randomised one, no intragroup comparisons were
made. The procedural success was 100% for each group, no
periprocedural morbidity. The hospital stay was 9 days for
surgical aorto bifemoral bypass patients, 5.8 days for
femoropopliteal patients. For those who underwent
endovascular intervention, average hospital stay was 3.4, 2.5
and 3 days respectively for the aorto-iliac, femoropopliteal and
“Below the Knee” level groups. The average pain score was
6.3 and 5.8 for surgical aortobifemoral bypass and
femoropopliteal bypass. Pain scores for the endovascular
intervention group was 4.4, 3.2 and 4.7 respectively for the
aortoiliac, femoropopliteal and “Below the Knee” level groups.
The improvement in the Rutherford gradings at six months
were Aorto bifemoral Bypass (4.6 to 3.6), Femoro-popliteal (4.1
to 2.6) in the surgical group and Aortiliac (4.4 to 3.4),
Femoropopliteal (4.2 to 2) and no change in the score for the
“Below the Knee” group. At six-month follow-up, Doppler
interrogation revealed a triphasic flow pattern in surgical and
endovascular bypasses involving the aortoiliac and
femoropopliteal segments. The doppler interrogation for the
“Below the Knee” lesions at six-month follow-up was biphasic
(n=3) to monophasic (n=1).
Conclusion: Surgical bypass and endovascular intervention
either as an independent treatment modality or in combination
as a Hybrid procedure looks promising in the management of
LEAD. Surgical bypass is no doubt morbid, but early results are
satisfactory in terms of patency rates and clinical improvement.
The early six months results of endovascular intervention, are
particularly encouraging in the femoropopliteal segment with
poor distal run off. The results are inconsistent for the “Below
the Knee” segment disease. TASC II- A and B lesions are
addressed by endovascular interventions, whereas TASC II- C
and D lesions are addressed by surgical bypass. Multidisciplinary individualised treatment approach should be
adopted in deciding which treatment to be provided for a
particular patient based on clinical, imaging findings and
institutional protocols