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Is infrainguinal bypass grafting successful following failed angioplasty?
R M Sandford1, M J Bown, R D Sayers
1Vascular Surgery group, Department of Cardiovascular Sciences, University of Leicester, Level 2 RKCSB, Leicester Royal Infirmary, Leicester LE2 7LX, UK. bex125@hotmail.com
Insights
Infrainguinal bypass surgery after failed angioplasty shows comparable outcomes to other bypass indications. This limb salvage procedure is effective when minimally invasive techniques fail.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Limb Salvage Procedures
Background:
- Angioplasty is a common treatment for lower limb ischemia, but it has a failure rate.
- Infrainguinal bypass grafting is often employed as a secondary procedure for limb salvage after angioplasty failure.
Purpose of the Study:
- To evaluate the outcomes of infrainguinal bypass grafting in patients whose previous angioplasty attempts failed.
- To compare the results of bypass surgery after failed angioplasty with those performed for other indications.
Main Methods:
- A retrospective review of all infrainguinal bypass cases at a single center over seven years.
- Cases were categorized into four groups: acute ischemia, chronic critical ischemia, failed angioplasty, and other indications.
- Survival analysis using Kaplan-Meier curves was performed to compare long-term patency and survival rates.
Main Results:
- Primary patency at 12 months was 61.2% in the failed angioplasty group versus 60.6% in other groups (P=1.11).
- Primary patency at 60 months was 50% in the failed angioplasty group compared to 40.6% in others (P=0.26).
- Survival rates at 12 months (74.2% vs 77.3%) and 60 months (33.3% vs 35.4%) were comparable between groups.
Conclusions:
- Infrainguinal bypass grafting following failed angioplasty yields outcomes similar to bypass surgery for other indications.
- Distal bypass surgery is a viable and effective option for limb salvage when endovascular techniques have not been successful.
Objectives:
Angioplasty is often used in the management of lower limb ischaemia and can reduce the need for infrainguinal bypass in some patients. There is an associated failure rate with this technique and bypass surgery is often used in this situation as a secondary limb salvage procedure. We aimed to evaluate the outcome of infrainguinal bypass grafting following failed attempt at angioplasty.
Methods:
All cases of infrainguinal bypass at a single centre over a seven year period were identified and notes reviewed. Cases were divided into four groups according to their indication for surgery; acute ischaemia, chronic critical ischaemia, failed angioplasty and an 'other' group including aneurysmal disease and claudicants. The failed angioplasty group was compared with the other three groups. Survival analysis was performed using Kaplan Meier curves and groups compared in terms of long term patency and survival.
Results:
Primary patency was 61.2% in the failed angioplasty group at 12 months compared with 60.6% in the other groups (P=1.11). There was also no significant difference in primary patency at 60 months (50% vs 40.6%, P=0.26). Survival at 12 months was also comparable between the groups (failed angioplasty group 74.2% compared with 77.3% in the other groups, P=0.662) as was 60 months survival (33.3% and 35.4% respectively, P=0.166).
Discussion:
In this study, outcome of infrainguinal bypass following failed angioplasty was comparable to outcome of surgery performed for another indication. This paper supports the use of distal bypass surgery for limb salvage in cases where minimal access techniques have failed.
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