Related Experiment Videos
Predictive factors for adverse outcome of pedal bypasses
F Biancari1, A Albäck, I Kantonen
1Division of Vascular Surgery, Department of Surgery, Helsinki, Finland.
Insights
Short pedal bypasses using the in situ saphenous vein technique, performed by experienced surgeons, yield the best outcomes for critical leg ischemia. Elevated C-reactive protein (CRP) levels preoperatively are associated with poorer results in foot revascularization.
Area of Science:
- Vascular Surgery
- Peripheral Artery Disease
- Reconstructive Surgery
Background:
- Critical leg ischemia (CLI) significantly impacts patient quality of life and limb viability.
- Infrainguinal bypass to foot arteries is a crucial revascularization strategy for CLI.
- Identifying factors influencing bypass graft success is essential for optimizing patient outcomes.
Purpose of the Study:
- To determine the risk factors affecting the success of bypass grafts to the foot arteries.
- To identify predictors of primary patency, secondary patency, leg salvage, and survival in patients undergoing pedal bypass.
Main Methods:
- A longitudinal observational study was conducted at a single institution.
- 165 infrainguinal bypasses to foot arteries were performed in 149 patients with CLI.
- Outcomes were assessed over 3-year follow-up, analyzing graft patency, leg salvage, and survival rates.
Main Results:
- Primary patency rates at 3 years were 34%, with secondary patency at 41%.
- Leg salvage and survival rates at 3 years were 60% and 55%, respectively.
- Lower preoperative C-reactive protein (CRP) levels, shorter grafts, distal inflow, experienced surgeons, and in situ saphenous vein grafts were associated with better outcomes. Pedal run-off scoring did not impact results.
Conclusions:
- Short pedal bypasses utilizing the in situ saphenous vein technique, performed by experienced surgeons, demonstrate the most favorable outcomes.
- Elevated preoperative CRP concentrations are a significant negative predictor for revascularization success in foot artery bypass surgery.
Objective:
to identify the risk factors affecting the outcome of bypass grafts to the foot arteries.
Design:
longitudinal observational study from a single institution.
Materials And Methods:
one-hundred and sixty-five infrainguinal bypasses to the foot arteries were performed in 162 legs of 149 patients with critical leg ischaemia.
Results:
at 1-month, 1-year, 2-year and 3-year follow-up, the primary patency rates were 74%, 43%, 38% and 34%, the secondary patency rates were 82%, 50%, 47% and 41%, the leg salvage rates were 88%, 66%, 66% and 60%, survival rates were 95%, 76%, 69% and 55%, whereas 82%, 53%, 49% and 36% of patients were alive with salvaged leg, respectively. Low preoperative plasma concentrations of C-reactive protein (CRP) and short grafts with more distal arterial inflow had a better outcome. Better primary and secondary patency rates were also achieved by experienced surgeons and by the use of in situ saphenous vein grafts. Pedal run-off scoring did not have any impact on the outcome of pedal bypasses.
Conclusions:
short pedal bypasses using in situ saphenous vein technique, done by an experienced surgeon, have the best outcome. Revascularisation to the foot arteries may carry a poor outcome in patients with elevated preoperative CRP concentration.