Reoperations for occluded arterial bypasses in the lower limbs

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Arterial Bypass Outcomes

Background:

• Review of reoperation outcomes for 29 patients (30 limbs) with occluded lower limb arterial bypasses.
• Study period: May 1996 to September 2005.

Purpose of the Study:

• To evaluate the effectiveness of reoperations for occluded lower limb arterial bypasses.
• To compare outcomes of thrombectomy alone versus thrombectomy with inflow/outflow reconstruction.

Main Methods:

• 44 reoperations performed on 30 limbs: thrombectomy alone (Group T, 27) or thrombectomy with inflow/outflow reconstruction (Group C, 17).
• Reconstruction types included axillary-femoral, aorta-iliac, aorta-femoral, and various below-knee bypasses.
• Graft materials: Polytetrafluoroethylene (PTFE) for above-knee, autovenous or combined grafts for below-knee reconstructions.

Main Results:

• Significant increase in Fontaine stage III and IV patients from primary to reoperation (60% to 86.7%).
• Cumulative patency rate was 28.6%; average patency duration was similar between groups T and C.
• High failure rate within 1 month (19/42 reoperations); limb amputation rate was 35.71%, with a limb salvage rate of 64.29%.

Conclusions:

• Reoperation for occluded lower limb bypasses is associated with advanced disease stages.
• Thrombectomy combined with inflow/outflow reconstruction offers better patency than thrombectomy alone for re-occluded bypasses.