Endovascular Recanalization of Native Superficial Femoral Artery Chronic Total Occlusion After Failed Bypass Graft: Mid-term Results.

Abstract Purpose To evaluate the safety, effectiveness and outcomes of endovascular revascularization of superficial femoral artery (SFA) chronic total occlusion (CTO) in patients with critical limb ischemia (CLI) after failed bypass graft. Material and Methods Endovascular recanalization of SFA CTO was performed for 26 consecutive CLI patients with failed bypass graft from 2016 to 2020. Patient demographics, bypass and lesion characteristics, procedural data, technical and clinical outcomes were noted. Results Technical success was 96.2% (25/26). Retrograde arterial access was used in 16 patients (61.6%). Additional tibial and iliac angioplasty was performed in 15 and 2 patients. Fifteen complications occurred in 10 patients, including thrombosis, embolism, vessel rupture, dissection, arteriovenous fistula, and pseudoaneurysm. Pain relief and wound healing were achieved in 22 patients. Primary, assisted primary, and secondary patency rates were 95.5%, 100%, and 100% at 6 months, 81.8%, 95.5%, and 100% at 12 months, and 76.7%, 82.7%, and 87.5% at 24 months. By univariate analysis, hyperlipidemia (hazard ratio [HR] 7.823; 95% confidence interval [CI] 1.274-48.038, p = 0.026) was found to be the only significant risk factor related to primary patency loss. Amputation-free survival and limb salvage rates were 100% and 100% at 6 months, 100% and 100% at 12 months, and 87.1% and 93.8% at 24 months. Conclusion Endovascular recanalization of SFA CTO in CLI patients with graft failure is effective with high technical success rates. Acceptable limb salvage and amputation-free survival rates make this technique a reasonable alternative to surgery in high risk patients.