A 65-year-old diabetic with chronic limb-threatening ischaemia (CLTI) has an ankle-brachial pressure index (ABPI) of 0.45 on the right. Angiography shows a long (18 cm) SFA (superficial femoral artery) occlusion with a patent popliteal artery and two-vessel run-off to the foot. He has a suitable great saphenous vein. The preferred revascularisation is:

• A Balloon angioplasty and stenting of the SFA
• B Femoropopliteal bypass using autologous great saphenous vein (above-knee) ✓
• C Primary amputation
• D Prostanoid infusion (PGE1) only

Explanation

For a long (>15 cm) SFA occlusion in a patient with CLTI and good vein conduit, surgical bypass (femoropopliteal bypass with reversed or in-situ great saphenous vein) provides superior long-term patency compared to endovascular intervention (angioplasty/stenting), which has high re-occlusion rates for TransAtlantic Inter-Society Consensus (TASC II) D lesions. Autologous vein is always preferred over prosthetic conduit below the knee.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.