الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Chronic lower extremity ischemia, also known as peripheral arterial disease (PAD) is the most common cause of loss of normal walking ability seen by the vascular specialist. Vein bypass is still considered the “gold standard”for the treatment of femoropopliteal occlusive disease. If autologous venous conduit is unavailable, however, surgical options are limited to the use of prosthetic material for femoral-popliteal bypass. Endovascular treatment (ET) is increasingly option for treating infrainguinal peripheral arterial disease (PAD). Percutaneous transluminal angioplasty (PTA) with adjunctive stenting is a well-validated and increasingly used technology. Lesions previously thought amenable only to open surgical bypass can now be successfully managed percutaneously; however, there remains great debate on the type of endovascular treatment to be offered.
The aim of the this study was to evaluate and compare the results of endovascular versus open surgical reconstruction of femoropopliteal arterial occlusive disease in a randomized prospective fashion with follow up of the primary patency for 12 months.
The study was a prospective, randomized trial carried out at 2 centers in Alexandria, Egypt and Duesseldorf, Germany between September 2009 and May 2010. All study participants signed an informed consent agreement as a part of the initial enrollment. Patients with symptoms of claudication or critical limb ischemia were evaluated for treatment. Clinical examination, ankle-brachial index and color-flow duplex ultrasonography were used to confirm infra-inguinal disease. Computed tomography angiography was used to evaluate the location and extent of lesions in femoropoliteal arteries.
120 enrolled patients were prospectively randomized prior to intervention into one of two main treatment groups: 60 patients were enrolled in open surgery group (group A) which was further subdivided into 2 subgroups: 30 patients in autogenous vein graft (subgroup AI), and 30 patients in synthetic graft (Dacron or PTFE) (subgroup AII). 60 patients were enrolled in endovascular intervention group (group B) which was further subdivided into 2 subgroups: 30 patients in Epic self expanding nitinol stent (subgroup BI), and 30 patients in percutaneous balloon angioplasty(PTA) (subgroup BII).
Femoropopliteal vein graft bypass and synthetic graft bypass were performed in the standard fashion. Techniques for percutaneous balloon angioplasty and for stenting were performed in the standard fashion either by antegrade femoral puncture in distal SFA lesions or crossover technique in proximal SFA lesions.
Follow up included clinical examination, ankle brachial index (ABI) immediate postoperative, 6 and 12 months later. During the follow up period, any patient complaining of recurrence of symptoms was subjected to ABI assessment, duplex ultrasound scan: using the B mode imaging for detection of stenosis and the spectral doppler to assess the peak systolic velocity ratio which is calculated by dividing the maximum peak systolic velocity recorded across the stenosis by the peak systolic velocity recorded in a normal area of the artery just proximal to the stenosis. In the present study, peak systolic velocity ratio equal or greater than 2.5 was considered as loss of primary patency.