What are the treatments for lower extremity arterial occlusive disease?

Lower limb arterial occlusive disease is currently a common disease in vascular surgery. The most important reason is that it can cause ischemic function in the patient's lower limbs. Because most patients are distributed in the population over 50 or 60 years old, at this age, because the body's bone density decreases, and the amount of exercise and vitality begin to decrease, it will also be an important factor that causes patients to develop the disease. The population in different countries has reached about 25%. Usually, the older the age, the more likely it is to develop the disease. For this, we need to understand the treatment methods.

There was no statistical significance in surgical treatment. The study by Sala et al. [6] also showed that the 4-year patency rates of autologous vein and artificial blood vessel above-knee bypass were 82.2% and 80.6%, respectively, and the 4-year secondary patency rates were 84.7% and 79.5%, respectively, with no statistically significant difference. According to our experience, no matter which graft material is chosen, the main factors affecting the short-term (within 30 days) patency rate are the patient's vascular inflow and outflow conditions, perioperative anticoagulation measures and the doctor's technical operation, while the main factors affecting the long-term (> 90 days) patency rate are the progression of arteriosclerosis, intimal hyperplasia and restenosis of the anastomosis, and the progression of arteriosclerotic lesions.

2. Artificial vascular bypass: It mainly uses artificial blood vessels made of PTFE material to perform femoral artery bypass surgery. It is suitable for patients with poor autologous vein conditions, varicose veins, or whose great saphenous vein has been removed. It is generally believed that the 2-year patency rate of PTFE artificial blood vessel above-knee bypass surgery can reach or approach 70% to 80%, while the patency rate of below-knee bypass surgery is very low, only 30% to 40%. However, the 2-year patency rate can be increased to more than 50% by combining the distal end of the artificial blood vessel with the vein to form a composite bypass [7]. Artificial blood vessels are easy to obtain, making the operation simple and relatively traumatic. Under the conditions of good inflow tract blood flow pressure and outflow tract vascular conditions, relatively satisfactory clinical results can also be achieved. In recent years, with the advancement of vascular materials, heparin-coated polyester blood vessels have been used in clinical practice, and their long-term patency rate is significantly better than that of PTFE artificial blood vessels [8]. We feel that this type of heparin-coated blood vessel has good softness and suture needle feel, the needle hole is not prone to bleeding, and the short-term effect is satisfactory, but its long-term patency rate needs to be further confirmed.

3. Endovascular treatment, namely balloon dilatation or stent implantation: Endovascular treatment has attracted widespread attention due to its characteristics of less trauma and quick recovery. It is currently generally believed that for above-knee lesions in TASC grades A and B, endovascular balloon angioplasty and stent implantation are more effective, even better than arterial bypass surgery, while for TASC grades C and D, endovascular treatment is less effective. Surowiec et al. [9] reported that the patency rates of superficial femoral artery stent implantation were 86%, 80%, 75%, 66%, 60%, 58% and 52% at 3, 6, 12, 24, 36, 48 and 60 months, respectively. Galied et al. [10] summarized a large number of endovascular treatment data for lower extremity arterial occlusions, including 923 cases of balloon angioplasty and 473 cases of stent implantation. The 3-year patency rate of balloon angioplasty for stenotic lesions was 61%, and the 3-year patency rate of occluded lesions was 1.3%.

The 3-year patency rate of stent implantation was 63% to 66%.