Aggressive arterial reconstruction for critical lower limb ischaemia

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Lower Limb Ischemia

Background:

• Critical limb ischemia poses a significant challenge in vascular surgery.
• Limb salvage surgery aims to prevent amputation and improve patient outcomes.
• Preoperative assessment, including angiography, traditionally influences surgical candidacy.

Purpose of the Study:

• To evaluate the outcomes of arterial reconstruction for critically ischemic lower limbs.
• To determine the impact of preoperative angiographic selection on limb salvage success.
• To assess long-term graft patency and survival rates following femorocrural bypass.

Main Methods:

• A consecutive series of 315 patients with 329 critically ischemic lower limbs underwent arterial reconstruction.
• Patients were not excluded based on poor run-off on preoperative angiography.
• Femorocrural bypass to a single calf vessel was performed in 73% of cases, utilizing in situ long saphenous vein, arm vein, or composite grafts.

Main Results:

• The 30-day cumulative mortality rate was 7%, increasing to 41% at 5 years.
• Cumulative graft patency rates at 30 days, 1, 2, and 5 years were 96%, 85%, 84%, and 82%, respectively.
• Graft patency was independent of the level of reconstruction.

Conclusions:

• Arterial reconstruction for critical limb ischemia can achieve acceptable results without stringent preoperative angiographic selection.
• An aggressive approach to limb salvage surgery is justified, offering durable patency and limb preservation.
• The choice of conduit (saphenous vein, arm vein, or composite grafts) did not significantly alter outcomes.