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Inframalleolar bypass grafts for limb salvage
F C Brochado Neto1, M V M Cury, V S Costa
1Hospital do Servidor Publico Estadual Sao Paulo (HSPE)--Department of Vascular Surgery, Sao Paulo, SP, Brazil.
Insights
Inframalleolar bypass surgery offers a viable long-term solution for limb salvage in patients with critical ischemia. This procedure helps preserve deambulation and survival rates, though results vary by patient factors.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Lower Extremity Revascularization
Background:
- Critical limb ischemia (CLI) poses a significant challenge, often necessitating complex revascularization strategies.
- Inframalleolar bypass is indicated when tibial arteries are unsuitable for bypass, requiring distal targets in the foot.
Purpose of the Study:
- To evaluate the long-term efficacy and outcomes of inframalleolar bypass surgery.
- To assess graft patency, limb salvage, deambulation, and survival rates following this procedure.
Main Methods:
- Retrospective analysis of 122 inframalleolar bypasses in 116 patients (1991-2005).
- Predominant use of dorsalis pedis for distal anastomosis (62.3%) and greater saphenous vein conduit (84.4%).
- Analysis of endpoints including graft patency, limb salvage, deambulation, and survival over 1-60 months.
Main Results:
- Cumulative patency rates were 58.2% at 3 years and 53.4% at 5 years.
- Limb salvage rates were 70.0% at 3 years and 50.4% at 5 years, with preserved deambulation.
- Survival rate at 3 years was 50.2%, with a surgical mortality of 13%; female sex correlated with poorer outcomes.
Conclusions:
- Inframalleolar bypass is a satisfactory long-term option for limb salvage in select patients.
- The procedure can effectively restore perfusion to the foot, preserving function and reducing amputation rates.
Objective:
To report our experience of long-term results of inframalleolar bypass.
Design:
Retrospective analysis.
Materials And Methods:
We analysed 122 inframalleolar bypasses performed between January 1991 and June 2005 in 116 patients. Most patients were treated for critical ischaemia (97%). The indication for the use of podalic arteries was a lack of tibial arteries with run-off to the foot. The dorsalis pedis was predominantly used for distal anastomoses (62.3%) and the greater saphenous vein (84.4%) as the conduit. The follow-up periods ranged from 1 to 60 months. The endpoints analysed were graft patency, limb salvage, preservation of deambulation and survival rate.
Results:
The cumulative patency was 58.2% at 3 years and 53.4% at 5 years. The best results were achieved with the devalvulated greater saphenous veins. Limb salvage was 70.0% at 3 years and 50.4% at 5 years, with preserved deambulation rates of 57.3% and 47.1%, respectively. There were 36 major and 45 minor amputations. At 3 years, the survival rate was 50.2% and the surgical mortality 13%. Female sex was associated with worse results for cumulative patency and limb salvage (P<0.01).
Conclusions:
In the long term, inframalleolar bypass is a satisfactory option for limb salvage.
