Evaluation of Therapeutic Effects on Collateral Circulation in Patients with Chronic Leriche Syndrome: a Case-Control Study of Intraluminal Stent Implantation and Surgical Bypass Grafting.

Purpose: The aim of the study was to compare the hemodynamic effects of endoluminal and open surgical treatment of chronic Leriche syndrome using arterial collaterals on CTA as a surrogate parameter.

Materials And Methods: This retrospective, single-center study included 30 patients with chronic Leriche syndrome. Fourteen patients underwent intraluminal stent implantation (endo group), and sixteen underwent surgical bypass grafting (surgical group). CTA was performed pre- and postoperatively, and a series of evaluation parameters (a: sum of area of the systemic collateral pathways in the abdominal wall before operation, a: sum of area of the systemic collateral pathways in the abdominal wall after operation, a: area of lumen of the stent or artificial vessel, BSR: post- and preoperative blood supply ratio = (a + a)/a, RR: reduction rate of systemic collateral arteries after the operation = (a-a)/a) were defined to quantitatively evaluate the hemodynamic effects of the treatments. Short-term clinical outcomes, including improvement of symptoms, postoperative complications and in-hospital stay, were also collected. Then, the effects of the two operations were compared.

Results: There was no significant difference in the baseline (a, p = 0.301) and postoperative (a, p = 0.802) collateral arteries, as well as BSR (p = 0.088) and RR (p = 0.592) between endo and surgical groups. There was also no significant difference in short-term clinical outcomes between the two groups.

Conclusion: Our limited series suggests that intraluminal stent implantation may not be inferior to surgical bypass grafting regarding the undifferentiated short-term clinical outcomes as well as the chosen hemodynamic surrogate parameters.