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Popliteal-to-distal bypass grafts for critical leg ischaemia
F Biancari1, I Kantonen, A Albäck
1Division of Vascular Surgery, Helsinki University Central Hospital, Finland.
Insights
Popliteal-to-distal bypass surgery offers a valuable solution for severe infrapopliteal arterial disease, achieving good limb salvage rates. However, diabetic and uraemic patients face higher risks of leg and life loss.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease Management
Background:
- Critical leg ischemia necessitates revascularization strategies.
- The popliteal artery serves as a potential inflow source for infrapopliteal bypass.
- Assessing the efficacy of popliteal-to-distal bypass is crucial for limb salvage.
Purpose of the Study:
- To evaluate the effectiveness of revascularization to crural and pedal arteries using the popliteal artery as inflow.
- To determine the outcomes of popliteal-to-distal bypass in patients with critical leg ischemia.
Main Methods:
- Retrospective study of 62 patients with critical leg ischemia undergoing 66 popliteal-to-distal bypass procedures.
- Follow-up averaged 15.2 months, assessing bypass graft patency, leg salvage, survival, and patient survival with limb.
- Procedures included popliteal-crural and popliteal-pedal bypass grafts.
Main Results:
- At 2-year follow-up, primary patency was 55%, secondary patency 67%, and leg salvage 88%.
- Overall survival at 2 years was 72%, with 66% of patients alive with their leg.
- Above-knee popliteal bypasses showed superior primary patency compared to below-knee bypasses (p=0.02).
Conclusions:
- Popliteal-to-distal bypass is a viable option for severe infrapopliteal atherosclerotic disease.
- Diabetic and uraemic patients have significantly higher risks of limb and life loss post-revascularization.
- Above-knee popliteal artery inflow may yield better graft patency rates than below-knee inflow.
Background:
To assess the value of revascularization to crural and pedal arteries using the popliteal artery as inflow source.
Experimental Design:
Retrospective study with a mean follow-up period of 15.2 months (range, 0-46).
Setting:
Academic referral center.
Patients:
62 patients with critical leg ischaemia and popliteal artery suitable as inflow source for infrapopliteal arterial revascularisation.
Interventions:
66 popliteal-to-distal bypass procedures, of which 18 popliteal-crural bypass grafts and 48 popliteal-pedal bypass grafts.
Main Outcome Measures:
Bypass graft patency, leg salvage, survival and success defined as patients alive with leg.
Results:
At 1-month, 1-year, and 2-year follow-up, the primary patency rates were 87%, 58%, and 55%, secondary patency rates were 95%, 70%, and 67%, leg salvage rates were 97%, 88%, and 88%, while 88%, 70%, and 66% of patients were alive with legs at the same intervals. At 2-year follow-up the survival rate was 72%. Above-knee popliteal-to-distal bypasses achieved better primary patency (p=0.02) and corrected primary patency rates (p=0.01) than below-knee popliteal-to-distal bypasses. Diabetes and uraemia affected the survival and patients alive with leg rates.
Conclusions:
Popliteal-to-distal bypass surgery is worthwhile for the management of severe, isolated infrapopliteal atherosclerotic disease. Diabetic and uraemic patients are at high risk for both leg and life loss after revascularisation. Grafts originating from the above-knee popliteal artery may achieve better patency rates than those originating from the below-knee popliteal artery.