Publication details
Pedal bypass grafting in the treatment of chronic critical lower limb ischaemia
| Authors | |
|---|---|
| Year of publication | 2011 |
| MU Faculty or unit | |
| Citation | |
| Description | Objective: Patients who underwent pedal bypass grafting during the last decade were evaluated. All were at high risk for lower-extremity amputation and the possibilities of endovascular and conservative therapy were exhausted. Methods: In the period of February 2001–July 2010, 110 pedal bypass procedures (using utogenous vein graft) were carried out in 110 patients with chronic critical lower limb ischaemia. The group included 82 men (74.5%) and 28 women (25.5%) with an average age of 67 (range 28–84) years. In this group 73 (66.4%) had diabetes. Gangrene or tissue loss was diagnosed in 93 limbs (84.5%), rest pain was recorded in 8 (7.3%), acute thrombosis of crural arteries in five (4.5%) and trauma in four (3.6%) limbs. Statistical data were analyzed to assess the influence of patient diabetes, pedal bypass length, distal anastomosis placement and spliced graft use on the long-term results. Using Kaplan–Meier survival analysis, primary and secondary bypass patency and the limb salvage rates were evaluated both in the whole patient group and in the subgroups. The results between the relevant subgroups were compared using the Log Rank test (confidence intervals 95%, level of significance p=0.05). Results: With the exception of one patient, healing of the wound was achieved in all limbs with functioning pedal bypass. In four limbs it was necessary to use a free muscle flap whose artery was anastomosed to the pedal bypass. At follow-up period (average 30+-26.4 months; range 1.2–91.2 months), bypass occlusion occurred in 21 limbs; in eight of them it was managed by early intervention. None of the patients died during the surgical procedure. The 30-day postoperative mortality was 1.8%. The cumulative primary and secondary patency rates were 67.2% and 69.5%, respectively; the cumulative probability of limb salvage was 78.0%. Diabetes mellitus has no influence on long-term bypass patency and limb salvage. Bypass grafts shorter in length showed higher both primary and secondary patency rates. The site of target artery anastomosis did not affect long-term results, but the use of spliced grafts had adverse effects on the bypass primary patency. Conclusions: Pedal bypass grafting is safe and effective method, which provide very good long-term results in the treatment of chronic critical lowerextremity ischaemia, including diabetic gangrene, in patients with occlusive disease of the crural arteries. |