Functional Outcome of Distal Bypasses for Lower Limb Ischemia (original) (raw)
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International Journal of Surgery Open, 2019
Background: Peripheral occlusive arterial disease (POAD) is a steadily increasing global epidemic. Femoropopliteal bypass (FPB) is the traditional therapeutic option whenever endovascular treatments failed or not indicated. We present our experience in lower limb revascularization. Patients and methods: Prospective observational cohort single center study included 158 patients with intermittent claudication (IC) or critical limb ischemia (CLI). The patients were placed in 7 Rutherford categories & their angiographic findings were graded according to Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) criteria. The ipsilateral great saphenous vein was used for revascularization. Results: male patients were 113 (71.5%); female were 45 (28.5%). Age ranged from 39 to 77 years, with a mean of 60.7 ± 7.8 years. About 79.1% of patients were in the 6th & 7th decades. Only 26 patients (16.5%) had severe IC & 83.5% had CLI. Almost all patients with Rutherford category 3e6 had an ankle brachial index (ABI) less than 0.70. Most Femoropopliteal lesions (n ¼ 115, 72.8%)near half infrapopliteal lesions (n ¼ 74, 46.8%) were of TASC II B & C types. Majority of patients received a vein graft. Distally, 100 grafts (66.7%) were sutured below the knees whereas the remainder were either behind (n ¼ 31) or above the knees (n ¼ 8). The follow up ranged from 1 month to 11 years. One & 5 year patency rates of vein grafts were 88.7% & 70.2% respectively. Conclusions: FPB using saphenous graft yield a very good graft patency, low rates of amputation, morbidity and mortality. Long-term patency is excellent.
European Journal of Vascular and Endovascular Surgery, 2011
Objectives: Compare the outcome of distal (bypass to the crural arteries) versus ultradistal (bypass to the pedal arteries) bypasses in patients with critical leg ischaemia (CLI). Design: Retrospective analysis of prospectively collected data of patients with CLI undergoing infra-popliteal bypass surgery is performed. Materials and Methods: Patients undergoing infra-popliteal bypass at a single institution between 2004 and 2010 are included. Patency rates at 1-year and amputation-free survival at 12 and 48 months are analysed. Results: Two hundred and thirty bypasses were performed in 209 consecutive patients (156 men, median age; 76 years, range; 19e96 years). One hundred and seventy nine (78%) bypass were classified as distal and 51 (22%) as ultradistal. The incidence of diabetes mellitus was significantly higher in the ultradistal group (p Z 0.0025). At 1-year, the distal group primary, assisted-primary and secondary patency rates were 61.7%, 83.1% and 87.4% compared to 61.9%, 87.4% and 87.4% in the ultradistal group respectively. Amputation-free survival at 12 and 48 months was 82.9% and 61.5% in the distal group compared to 83.0% and 64.9% in the ultradistal group. Conclusions: This study show that both distal and ultradistal bypass have comparable outcome regardless of the co-morbidities. The authors believe that elderly patients should be offered ultradistal bypass if indicated to avoid major amputation.
Role of crossover bypasses in the treatment of ischemia of the lower extremity
Croatian medical journal, 1998
To evaluate the role of crossover bypasses in the treatment of the lower extremity ischemia. A retrospective study (1978-1997) included 51 patients with 52 femoro- or iliofemoral crossover bypasses. The most frequent indication for crossover bypass was unilateral thrombotic occlusion of the bifurcated graft or unilateral pelvic occlusion (49.0%) and the rest pain (40.4%). The main type of crossover reconstruction was "U" shaped, subcutaneous femorofemoral bypass. The first, third, and fifth year primary patency rates were evaluated using the life table analysis method. The cumulative patency rates were 91.3%, 73.9%, and 54.5% at 1, 3, and 5 years, respectively. Limb amputation had to be performed in five (9.6%) failed reconstructions. In four (7.7%) cases, thrombosis of reconstruction, and in one (1.9%) case, graft infection, caused the bypass occlusion. One patient (1.9%) died within 30 days after surgery from an acute myocardial attack. Crossover bypass is an attractive ...
Outcomes of lower extremity bypass performed for acute limb ischemia
Objective-Acute limb ischemia remains one of the most challenging emergencies in vascular surgery. Historically, outcomes following interventions for acute limb ischemia have been associated with high rates of morbidity and mortality. The purpose of this study was to determine contemporary outcomes following lower extremity bypass performed for acute limb ischemia.
The efficacy of salvage interventions on threatened distal bypass grafts
Journal of vascular surgery, 2015
Infrapopliteal bypass is an established and effective method for limb salvage in patients with critical limb ischemia. Secondary interventions maybe required to maintain graft patency. The aim of this study was to look at the frequency and outcomes of such interventions. Consecutive patients undergoing bypasses onto the infrapopliteal vessels for critical limb ischemia (Rutherford 4-6) at a single institution were analyzed between 2009 and 2013. The primary end points were graft patency, amputation-free survival (AFS), and freedom from reintervention at 12 months by Kaplan-Meier analysis. A total of 114 infrapopliteal bypasses were performed in 102 patients. Distal anastomosis was on to the anterior tibial (n = 31), posterior tibial (n = 27), peroneal (n = 24), tibioperoneal trunk (n = 23), or dorsalis pedis artery (n = 9). Primary patency, assisted primary patency, and secondary patency was 57%, 76%, and 82%, respectively, at 12 months and 44%, 70%, and 80%, respectively, at 36 mon...
Functional outcomes in limb salvage vascular surgery
The American Journal of Surgery, 1994
BACKGROUND: The crisis in health care brings a new focus to defining successful outcomes of medical treatments. The surgical literature has been criticized for not assessing functional outcomes in addition to technical success. METHODS: We evaluated the functional outcomes of limb salvage surgery over 3 years in 38 patients 65 years of age and older with limb-threateplng ischemia. The RAND-36-hem Health Survey 1.0 was used as a health assessment tool.
Predicting functional status following amputation after lower extremity bypass
Annals of vascular surgery, 2012
Some patients who undergo lower extremity bypass (LEB) for critical limb ischemia ultimately require amputation. The functional outcome achieved by these patients after amputation is not well known. Therefore, we sought to characterize the functional outcome of patients who undergo amputation after LEB, and to describe the pre- and perioperative factors associated with independent ambulation at home after lower extremity amputation.
Endoluminal intervention for limb salvage after failed lower extremity bypass graft
Journal of Vascular Surgery, 2009
Background: Lower extremity bypass graft failure in patients with limb-threatening ischemia carries an amputation rate of greater than 50%. Redo bypass is often difficult due to the lack of conduit, adequate target, or increased surgical risk, and resultant limb salvage rates are reduced significantly compared with the index operation. We set forth to investigate whether endovascular treatment in this setting would result in an acceptable limb salvage rate. Methods: A single-institution, retrospective review from June 2004 to December 2007 of patients with failed grafts who underwent endovascular treatment with percutaneous balloon angioplasty (PTA) of their native circulation was performed. Stents were selectively used in cases of post-PTA residual stenosis or flow-limiting dissection. Technical success was defined as a residual stenosis less than 30%. Percutaneous attempts at bypass graft salvage were excluded. Demographics, comorbidities, procedural data, and follow-up information were recorded. Descriptive, logistic regression and life-table analyses were performed. Results: Twenty-four lower extremities were treated in 23 patients with failed bypass grafts. Average patency of the index graft before failure was 647 days (range 5-2758). Mean age was 68 years (range 51-85), 62% were male and 81% had diabetes mellitus (DM). 87.5% of limbs treated had TransAtlantic InterSociety Consensus (TASC) C and D lesions and 62% had multiple lesions. Technical success was achieved in 100%. Mean follow-up was 25.6 months. At follow-up, there were 17 PTA failures, which resulted in: amputation (4), redo-bypass (3), and redo-PTA (11). Freedom from surgical revision and PTA failure was 89% (؉/؊ 0.07 SE) and 28% (؉/؊ 0.09 SE) respectively. PTA secondary patency was 72% (؉/؊ 0.09 SE) and limb-salvage was 81% (؉/؊ 0.08 SE) at both 12 and 24 months. Overall survival was 83% (؉/؊ 0.07 SE) and 77% (؉/؊ 0.09 SE) at 12 and 24 months, respectively. Conclusions: Endovascular treatment of patients with previously failed bypass grafts results in a high rate of limb salvage. This is a reasonable option in selected patients and the primary choice in those with poor targets, conduit, or excess surgical risk. Endovascular salvage should be considered before proceeding to primary amputation.