الفهرس 
SURGICAL ANATOMY OF THE FEMORAL ARTERYOnly 14 pages are availabe for public view
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Abstract
Atherosclerosis of peripheral vessels or peripheral vascular disease (PVD) is the most common cause of symptomatic stenosis in human vascular tree. Risk factors for (PVD) include a positive family history, cigarette smoking, diabetes, hypertension, dyslipidemia, advanced age and physical inactivity (Anand and Creager, 2005).
The most common site for PVD is the femoropopliteal arterial segment in the lower limb, where more than 50% of atherosclerotic plaque lesions occur. The lesions may be focal and discrete or involve the entire 30 cm of the vessel. Stenosis, occlusions, or both may be present, although occlusions are three times more common than stenosis (Hertzer et al., 2004).
The aim of this study is to discuss, evaluate and compare the results of surgical bypass (natural or synthetic grafts) and endovascular intervention in patients with superficial femoral artery occlusive disease and based on the results to define the advantage and disadvantage for both treatment modalities of peripheral arterial disease.
Femoropopliteal vein graft bypass and synthetic graft bypass were performed in the standard fashion to 30 patients. Techniques for PTA with or without stenting were performed in the standard fashion either by antegrade femoral puncture in distal SFA lesions or crossover technique in proximal SFA lesions to 30 patients.
from this study we can conclude that the outcome is nearly equal in both groups of study as the short term result is nearly equal.
Primary patency results of both bypass surgery or endovascular intervention not significantly different for short term follow up, but after 1 year of follow up primary patency rates and limb salvage rates, bypass surgery had better outcome with no statistical significance. Diabetes mellitus, hyperlipidemia and renal impairment were good predictors for loss of long term primary patency. Longer lesions, poor distal runoff and occlusion were important predictors for loss of primary patency in any type of intervention. While, critical limb ischemia was a predictive for failure of primary patency in endovascular intervention.
from this studywe can recommend according to nearly equal clinical and statistical results over one year of follow up in both studied groups and advances in endovascular tools and techniques endovascular approach may be advisable in all patients with TASC B and C as first line of treatment and preserve open bypass surgery for subsequent interventions. Despite the higher primary patency rate and limb salvage rate in open bypass surgery group better than angioplasty but without statically significance results. Other parameters, such as the type of the bypass conduit available (prosthetic or vein) and the need for above- or below-knee intervention, should be considered before a decision for open versus endovascular intervention as a first-line therapy for fit patients is made.
Before clear implications for clinical practice, a large proportion of patients with lower extremity arterial disease have multilevel inflow/outflow pattern of disease is likely exist and need careful assessment for major arterial reconstructive surgery or endoluminal procedures in several a