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Crural or pedal artery revascularisation for limb salvage: is it justified?

H Van Damme1

  • 1Department of Cardiovascular and Thoracic Surgery, University Hospital of Liège, CHU du Sart-Tilman, Liège, Belgium. hvandamme@chu.ulg.ac.be

Acta Chirurgica Belgica
|May 25, 2004
PubMed

Insights

For patients with critical limb ischemia, limb-saving distal bypass surgery offers a viable alternative to primary amputation, improving quality of life and potentially offering cost-effectiveness.

Area of Science:

  • Vascular Surgery
  • Vascular Medicine
  • Geriatric Medicine

Background:

  • Increasing incidence of limb-threatening ischemia in aging populations.
  • Peripheral arterial occlusive disease commonly affects infrainguinal and infragenicular vessels.
  • Advances in vascular surgery enable reconstruction of crural and pedal vessels.

Purpose of the Study:

  • To evaluate the feasibility and durability of infrapopliteal bypasses.
  • To compare limb-saving distal bypass surgery with primary amputation for advanced limb-threatening ischemia.
  • To assess the quality of life and cost-effectiveness of both treatment options.

Main Methods:

  • Literature review of recent data on infrapopliteal bypasses.
  • Analysis of studies considering quality of life outcomes.
  • Cost-effectiveness assessment of limb-saving surgery versus amputation.

Main Results:

  • Infrapopliteal bypass surgery is feasible and durable in select patients.
  • Limb-saving surgery can improve quality of life compared to amputation.
  • Cost-effectiveness analysis indicates potential benefits of bypass in certain scenarios.

Conclusions:

  • Distal bypass surgery is a viable option for limb salvage in chronic critical limb ischemia.
  • Treatment decisions should consider patient frailty, comorbidities, and patient-reported outcomes.
  • Further research on long-term outcomes and cost-effectiveness is warranted.

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