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Femoro-distal bypass surgery at Groote Schuur hospital--4-year retrospective study
B P Mwipatayi1, P C Jeffery, P Motale
1Department of Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town.
Insights
Femoro-distal bypass outcomes for critical limb ischaemia were analyzed. Local sepsis and early postoperative ankle-brachial index significantly influenced results, suggesting extended graft surveillance is crucial.
Area of Science:
- Vascular Surgery
- Critical Limb Ischaemia Management
- Bypass Grafting Outcomes
Background:
- Critical limb ischaemia (CLI) poses a significant clinical challenge, often necessitating amputation.
- Femoro-distal bypass is a key surgical intervention for limb salvage in CLI patients.
- Understanding factors influencing bypass success is vital for improving patient outcomes.
Purpose of the Study:
- To analyze the demographics and outcomes of femoro-distal bypass surgery in patients with critical limb ischaemia.
- To identify factors impacting graft patency and limb salvage rates.
- To inform recommendations for post-operative graft surveillance.
Main Methods:
- Retrospective review of 57 patients undergoing femoro-distal bypass between January 1998 and December 2001.
- Analysis of patient demographics, graft types (reversed saphenous vein graft vs. in situ vein graft), and surgical outcomes.
- Statistical evaluation of factors influencing graft patency and limb salvage.
Main Results:
- The median patient age was 62 years, with 49% being diabetic. Overall 2-year mortality was 19.2%.
- No significant difference in graft patency was observed between reversed saphenous vein graft (40% at 2 years) and in situ vein graft (39% at 2 years).
- Local sepsis and early postoperative ankle-brachial index were the only significant predictors of outcome; diabetes, age, gender, and race did not influence results.
Conclusions:
- Surgical outcomes of femoro-distal bypass for CLI are primarily influenced by local sepsis and early postoperative ankle-brachial index.
- A substantial proportion of graft stenoses requiring intervention were detected beyond 18 months postoperatively.
- Graft surveillance programs should extend beyond 18 months to effectively manage potential complications.
Unlabelled:
An analysis of the demographics and outcome of femoro-distal bypass in patients presenting with defined critical limb ischaemia at Groote Schuur Hospital, Cape Town, is presented.
Materials And Methods:
A retrospective review was conducted between January 1998 and December 2001. During this period, 65 patients underwent femoro-distal bypass. Of these, 57 patients were analysed and 8 patients were excluded from the study because of incomplete medical records
Results:
The median age of the patients in this study was 62 years, with a male-to-female ratio of 34:23. Twenty-eight patients (49%) were diabetic. An overall 2-year mortality of 19.2% was recorded. Reversed saphenous vein graft (RSVG) was used in 29 legs (50.9%) and in situ vein graft (ISVG) in 19 legs (33.3%). There was no statistically significant difference in the graft patency between the two methods (p = 0.39); the 2-year cumulative patency was 40% for the RSVG and 39% for the ISVG. In our unit only 2 factors influenced the outcome of femoro-distal bypass--local sepsis in the foot and an increased early postoperative ankle-brachial index (p < 0.05). Diabetes mellitus, gender, age and race had no influence on the outcome. This study showed that the site of the distal anastomosis had no effect on graft patency or limb salvage. At 2 years, the cumulative patency and limb salvage rates were 40% and 56% respectively. Of the 11 grafts with stenotic lesions requiring intervention, 6 were detected between 18 and 24 months.
Conclusion:
Management of critical limb ischaemia is a major part of the workload in our unit, with most patients undergoing primary amputation. The surgical outcome of femoro-distal bypass was largely influenced by local sepsis and early postoperative ABI. We found that more than half the stenotic lesions detected during graft surveillance occurred beyond 18 months postoperatively. This suggests that a graft surveillance programme should continue beyond 18 months.
