Clinical Profile and Outcomes of Isolated Femoropopliteal Interventions in Chronic Limb Threatening Ischaemia in India

The incidence of diabetes and peripheral vascular disease is increasing in India. Open surgical bypass and balloon angioplasty (+ / − stenting) for femoropopliteal disease has become commonplace in vascular surgery. A single-centre, case-series analysis of patients presenting with significant, symptomatic, isolated superficial femoral artery, and/or popliteal lesions was carried out to determine the clinical profile and assess outcomes of patients undergoing these procedures. Patients undergoing adjuvant procedures for iliac or tibial diseases were excluded. Patient records with a minimum 24 months follow-up were retrospectively analysed. Sixty-five patients with isolated femoropopliteal interventions were analysed. Men were predominant (N = 52.80%), and the mean age was 60 years. Diabetics formed 80% of patients with atherosclerosis being the predominant aetiology (84.61%). 54.83% patients had concomitant foot infections. Most patients presented with ischaemic tissue loss (N = 41, 63.1%). TASC (Trans-Atlantic Inter-Society Consensus) B lesions were predominant among the angioplasty group (71.10%) and TASC C and D among the open surgical group (88.90%). A total of 38 patients underwent angioplasty, and 27 patients underwent femoropopliteal bypass. Stenting was carried out in 11 patients. 95.4% technical success was achieved. The majority of open bypass patients had a proximal popliteal outflow (59.30%) and a reversed saphenous vein graft as a conduit (92.59%). Primary patency was similar in both groups till 1 year (88.46 vs 63.16, P = 0.274). At 2 years, the open surgical group had higher patency than the angioplasty group (86.90% vs 40.74%, P < 0.001). No change in the amputation free survival at 1 year or 2 years was observed (P = 0.182 and 0.231, respectively). A total of 13.15% of patients underwent reintervention post angioplasty as compared to 3.70% after bypass during the follow-up period. Major amputation was carried out in 12.3% (8 patients). Freedom from major adverse limb events (88.89% vs 78.9%, P = 0.292), and overall survival (85.18% vs 71.05%, P = 0.182) were similar between groups. Eleven deaths were recorded during follow-up. Our case-series analysis reveals a younger, diabetic population undergoing isolated femoropopliteal interventions with open surgical bypass having a better primary patency rate compared to balloon angioplasty (+ / − stenting) at 2 years albeit with similar amputation free survival, freedom from major limb events, and overall survival.