Aortobifemoral bypass for the critically ischaemic limb--is it worth while?

Area of Science:

• Vascular Surgery
• Limb Salvage Procedures
• Aorto-iliac Occlusive Disease

Background:

• Critical limb ischemia poses a high risk of amputation.
• Aorto-iliac occlusive disease is a common cause of critical limb ischemia.
• The role of aortobifemoral bypass in stump salvage requires further investigation.

Purpose of the Study:

• To evaluate the efficacy of aortobifemoral bypass in limb and below-knee amputation stump salvage.
• To assess early and long-term outcomes of aortobifemoral bypass in patients with critical limb ischemia.
• To determine the limb or stump salvage rates associated with this surgical approach.

Main Methods:

• A retrospective study of 151 patients with aorto-iliac occlusive disease and threatened limbs.
• Patients underwent aortobifemoral bypass, divided into two groups based on amputation strategy.
• Group 1: Bypass with digital or transmetatarsal amputation; Group 2: Guillotine below-knee amputation.

Main Results:

• Overall limb or stump salvage rate within 1 month was 89.4%.
• Long-term follow-up (2-5 years) showed a 97% limb or stump retention rate.
• Early complications included myocardial infarction (3.3%) and groin wound sepsis (4.5%).

Conclusions:

• Aortobifemoral bypass is a successful procedure for salvaging limbs and below-knee amputation stumps in critical ischemia.
• The technique offers high rates of limb preservation, both in the short and long term.
• It is a valuable option for patients with aorto-iliac occlusive disease at risk of amputation.