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[Extraanatomic bypass surgery for peripheral arterial vascular disease--is it still justified?]
M Cechura1, V Treska, J Krizan
1Chirurgische Universitätsklinik des Fakultätskrankenhauses in Pilsen. Cechura@fnplzen.cz
Insights
Extraanatomic bypass surgery for lower limb ischemia shows good long-term success. These procedures are technically simple, offering low morbidity and mortality rates for patients.
Area of Science:
- Vascular Surgery
- Surgical Reconstruction
- Peripheral Artery Disease
Context:
- Retrospective analysis of 66 extraanatomic bypasses in 65 patients over 5 years.
- Focus on femoro-femoral, axillo-femoral, and obturator bypasses.
- High prevalence of critical lower limb ischemia (57.6%).
Purpose:
- To evaluate the efficacy and outcomes of extraanatomic bypass surgery for lower limb ischemia.
- To analyze bypass patency, complication rates, and long-term survival.
- To assess the role of these procedures in managing critical limb ischemia.
Summary:
- Bypass patency rates of 97% at 1 year and 81.1% at 3 years.
- Low overall complication rate (24.2%), with major complications in 12.1%.
- 3-year mortality rate of 10.8% and amputation rate of 7.6%.
Impact:
- Extraanatomic reconstructions are a valuable surgical option for lower limb ischemia.
- These technically simple procedures offer good long-term success with low patient morbidity and mortality.
- Demonstrates the effectiveness of extraanatomic bypasses in limb salvage and improving patient outcomes.
Objective:
Our results of extraanatomic bypass surgery in the last 5 years should be analysed in a retrospective study.
Patients And Methods:
66 extraanatomic reconstructions were performed in 65 patients (52 male, 13 female). Femoro-femoral bypasses (78.8 %) were mainly included in this study, followed by axillo-femoral (bifemoral) and obturator bypasses. The procedures could be divided in 45 (68.2 %) primary and 21 (31.8 %) recurrent operations. 57.6 % of the patients revealed a critical lower limb ischemia.
Results:
The bypass patency rates were 97 % after one year and 81.1 % after 3 years. 24.2 % of the patients showed immediate postoperative complications, 12.1 % of them major complications (surgical and nonsurgical). No patient died postoperatively or in the first year after operation. The 3-year mortality rate ranged to 10.8 %. Major amputations had to be carried out in 4 patients (6.1 %) during the first year and in one patient later on, so that the total amputation rate amounted to 7.6 %.
Conclusions:
Our results prove extraanatomic reconstructions to be a valuable surgical tool in lower limb ischemia with good long-term success. Extraanatomic bypasses are technically simple procedures in the majority of cases and take good care of the patient with low morbidity and mortality.