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[The analysis of the follow-up results for the crural artery bypass]
Feng Lu1, Hao Zhang, Ya-Xue Shi
1Department of Vascular Surgery, Renji Hospital, Medical College of Shanghai Jiao Tong University, Shanghai 200001, China.
Insights
Crural artery bypass surgery offers a feasible solution for patients with critical limb ischemia due to extensive femoral or popliteal artery disease. Enhanced follow-up and early intervention improve limb salvage and secondary patency rates.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Peripheral Artery Disease
Context:
- Patients with long stenosis or occlusion in the femoral and popliteal arteries often face amputation.
- Endovascular interventions may fail for complex arterial disease.
- Critical limb ischemia (CLI) affects a significant portion of these patients (93.8%).
Purpose:
- To evaluate the follow-up outcomes of crural artery bypass surgery.
- To assess the efficacy of femoral-crural or femoral-popliteal-crural bypass in limb salvage.
- To analyze changes in ankle-brachial index (ABI) and patency rates post-surgery.
Summary:
- Femoral-crural bypass surgery was performed on 65 limbs in 64 patients with severe lower extremity arterial disease.
- Post-surgery, the ankle-brachial index improved significantly, and perioperative mortality/amputation rates were low (1.6% and 1.5%, respectively).
- The follow-up limb salvage rate was 85.2% over an average of 24.1 months, with a notable decrease in CLI to 13.0%.
Impact:
- Crural artery bypass is a viable option for limb salvage when endovascular treatments fail or are not suitable.
- Improved follow-up and early intervention strategies can enhance secondary patency and limb salvage rates.
- The study demonstrates the long-term benefits of bypass surgery in restoring perfusion and preventing amputation in CLI patients.
Objective:
To review the follow-up results of the crural artery bypass.
Methods:
Sixty-five limbs in 64 patients with long stenosis or occlusion in femoral artery and popliteal artery were performed 65 times femoral-crural artery bypass surgery or femoral-popliteal-crural bypass surgery during April 2001 to July 2007. The ankle-brachial index before bypass surgery was 0.35 +/- 0.20 in anterior tibial artery and 0.38 +/- 0.21 in posterior tibial artery. Critical limb ischemia was 93.8%.
Results:
The ankle-brachial index after bypass surgery was 0.84 +/- 0.26 in anterior tibial artery and 0.83 +/- 0.22 in posterior tibial artery. The perioperative mortality rate was 1.6%, the perioperative amputation rate was 1.5%. Fifty-four patients 54 limbs were followed up. The average follow-up time was (24.1 +/- 16.6) months. The follow-up limb salvage rate was 85.2%. The follow-up mortality rate was 25.9%. Critical limb ischemia decreased as 13.0%. The follow-up ankle-brachial index was difference with before and after bypass surgery as 0.66 +/- 0.26 in anterior tibial artery and 0.64 +/- 0.25 in posterior tibial artery. It was no difference in cumulative limb salvage rate, cumulative primary and secondary patency rate by comparing autogenous vein with composite vascular as graft and comparing femoral-crural artery bypass surgery with femoral-popliteal-crural bypass surgery as surgical method.
Conclusions:
When the patients are failed in endovascular intervention or have long stenosis or occlusion in femoral artery and popliteal artery to face to amputation, the crural artery bypass is a feasible method. It's helpful to improve the secondary patency rate and limb salvage rate by enhancing the follow-up after operation and early intervention.
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