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[In situ bypasses in limb salvage. Late results and patency factors]
1Service de Chirurgie Vasculaire, Hôpital Central, Nancy.
Insights
In situ venous bypass successfully salvaged 72% of limbs with critical ischemia over 5 years. Key factors for graft patency included anastomosis site and popliteal artery quality.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
Context:
- Critical limb ischemia (CLI) affects patients with severe peripheral artery disease.
- Surgical interventions aim to restore blood flow and salvage limbs.
- In situ venous bypass is a technique used for femoropopliteal or femorotibial revascularization.
Purpose:
- To evaluate the effectiveness of in situ venous bypass for limb salvage in patients with critical limb ischemia.
- To determine the long-term patency rates of these bypasses.
- To identify factors influencing the success of the procedure.
Summary:
- A study of 100 limbs with critical ischemia (stages III-IV) treated with in situ venous bypass showed a 72% limb salvage rate at 5 years.
- The 5-year primary and secondary patency rates were 51% and 62%, respectively.
- Graft patency was significantly influenced by the lower anastomosis site and the quality of the popliteal artery segments (p<0.05).
Impact:
- Demonstrates the viability of in situ venous bypass for limb salvage in CLI.
- Provides insights into factors affecting long-term graft success.
- Informs surgical decision-making for complex peripheral artery disease cases.
Abstract:
One hundred limbs with critical ischemia (stages III and IV) were saved from 1983 to 1987 by in situ venous bypass at the lower femoropopliteal or femorotibial level. The average age of the patients was 66 (40-89) years. The surgical indication involved 51 cases of stage III ischemia and 49 of stage IV. The etiology of the ischemia was occlusive chronic arteritis (n = 67), diabetic arteritis (n = 20), embolic disease (n = 10) and aneurysmal disease (n = 3). The systolic pressure index in the ankle recovered an average value of 0.42 preoperatively. In 48 cases, the distal implantation of the graft was on the lower popliteal artery, and on the arteries of the leg in 52 cases. During the immediate postoperative period, 8 patients died and 13 underwent amputation. At 5 years, the limb salvage rate was 72%. The primary patency at 5 years, calculated with the actuarial method, was 51% and the secondary patency at 5 years was 62%. Among the factors likely to significantly influence patency, only the site of the lower anastomosis and the quality of the III and IV segments of the popliteal artery were selected (p less than 0.05), while the number of patent vessels in the leg and the clinical stage did not influence patency.