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Results of infrainguinal bypass surgery: an analysis of 263 consecutive operations
T Jämsén1, H Tulla, H Manninen
1Department of Clinical Radiology, Kuopio University Hospital, Finland. tiia.jamsen@kuh.fi
Insights
Infrainguinal revascularization effectively treats lower limb ischemia. Factors like diabetes and renal issues impact outcomes, but age is not a barrier to successful bypass surgery.
Area of Science:
- Vascular Surgery
- Peripheral Artery Disease
- Ischemia Management
Background:
- Lower limb ischemia poses significant challenges to patient mobility and quality of life.
- Infrainguinal revascularization aims to restore blood flow and prevent amputation.
Purpose of the Study:
- To evaluate the effectiveness of infrainguinal bypass surgery for treating lower limb ischemia.
- To identify factors influencing the success rates of these procedures.
Main Methods:
- A review of 263 infrainguinal bypass operations (femoropopliteal and femorodistal) in 226 patients.
- Analysis of initial success, patency rates, limb salvage, and survival.
- Clinical and Doppler ultrasound follow-up for a subset of patients.
Main Results:
- High initial success rate (92%) for infrainguinal revascularization.
- One-year primary patency of 70% and five-year secondary patency of 52%.
- Limb salvage rates of 82% (1 year) and 77% (5 years) for critical ischemia; diabetes and distal bypass negatively impacted salvage.
Conclusions:
- Infrainguinal revascularization is a successful treatment for lower limb ischemia across age groups.
- Atherosclerotic disease extent, diabetes, and renal insufficiency are key factors influencing outcomes and life expectancy.
Background And Aims:
The purpose of this clinical study was to assess the success of infrainguinal revascularization in the treatment of lower limb ischaemia.
Material And Methods:
226 consecutive patients underwent 263 femoropopliteal (n = 194) or femorodistal (n = 69) bypass operations during 1988-1996 at a university hospital. Records of all patients were reviewed. Late control visits including clinical and colour doppler ultrasound examinations were programmed for 109 patients. Initial success, primary and secondary patencies, limb salvage and survival rates were determined and factors affecting outcome were analysed in various patient categories.
Results:
Initial success rate was 92% (243/263). The primary and secondary patencies were 70/83% and 52/63% at one and five years, respectively. The corresponding limb salvage rates for patients with chronic critical ischaemia were 82% and 77%. The number of diseased vessels in the treated limb correlated negatively with the primary patency. Advanced age did not affect primary patency or limb salvage rates. Diabetes and the use of distal revascularizations were independent predictors of poorer limb salvage. Diabetes and renal insufficiency proved to shorten life expectancy.
Conclusions:
Infrainguinal revascularizations are effective regardless of patient's age. The extent of atherosclerotic changes in the operated limb, diabetes and renal insufficiency are factors affecting outcome.