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[Femoro-distal revascularization for "critical" chronic atheromatous ischemia. 695 cases]
J Marzelle1, J M Fichelle, G Alimi
1Service de Chirurgie vasculaire, Hôpital Saint-Joseph, Paris.
Insights
Femoropopliteal bypass surgery for critical limb ischemia shows a 5-year survival rate of 47% and a limb salvage rate of 76%. While bypasses can fail, this procedure offers a chance to save limbs, even with poor distal vessels.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Outcomes Research
Background:
- Critical limb ischemia (CLI) poses a significant challenge in vascular surgery.
- Femoropopliteal bypass is a key revascularization technique for CLI.
- Retrospective analysis of long-term outcomes is crucial for understanding treatment efficacy.
Purpose of the Study:
- To evaluate the outcomes of femoropopliteal bypass for critical chronic ischemia.
- To determine the long-term patency, limb salvage, and survival rates.
- To identify factors influencing the success of femoropopliteal bypass procedures.
Main Methods:
- Retrospective analysis of 600 patients undergoing femoropopliteal bypass over 10 years.
- Inclusion of 644 limbs and 695 bypasses in the analysis.
- Examination of hospital mortality, postoperative occlusion, amputation rates, and long-term survival and patency.
Main Results:
- Hospital mortality was 4.3%.
- Postoperative occlusion occurred in 16.5% of bypasses, with 9.8% requiring major amputation.
- Five-year survival was 47%, bypass patency was 50%, and limb salvage was 76%.
Conclusions:
- Femoro-distal revascularization is effective for limb salvage in critical limb ischemia, even with distal target vessels.
- Factors like age, diabetes, and surgical technique influence bypass success.
- Amputation significantly reduces life expectancy compared to successful revascularization.
Abstract:
The results of the revascularizations carried out over a 10-year period for "critical" chronic ischaemia, using the femoropopliteal bypass technique, have been retrospectively analyzed. In all, 600 patients underwent femoro-distal revascularization in 644 limbs, and 695 bypasses were performed. The hospital mortality rate was 4.3 percent. Among these 695 bypasses, postoperative occlusion occurred in 16.5 percent of the cases, and major amputations were necessary in 9.8 percent. The probability of 5-year survival was 47 percent. The probabilities of bypass patency and limb salvage were 50 and 76 percent respectively. The failure of revascularization ending in amputation did not significantly increase the postoperative mortality rate (4.1 percent versus 4.6 percent), but the life expectancy of patients who were amputated was significantly lower than that of patients who were not (55 +/- 5 percent versus 63 +/- 3 percent at 3 years; P = 0.03). The factors predictive of successful bypass were examined; they included age, clinical stage, diabetes, bypass material, site of distal implantation, revascularization procedure and reoperation. Femoro-distal revascularization makes it possible to cope with the challenge of limb salvage, even when the receiving vessel is an artery of the foot.