Popliteo-pedal bypass surgery for critical limb ischemia

Area of Science:

• Vascular Surgery
• Peripheral Arterial Disease
• Reconstructive Surgery

Background:

• Critical limb ischemia (CLI) from distal arterial disease poses significant clinical challenges.
• While open surgery may offer advantages over endovascular interventions for CLI, data specific to infra-popliteal disease is limited.

Purpose of the Study:

• To analyze the indications for and outcomes of popliteo-pedal bypass procedures.
• To evaluate the effectiveness of autologous vein grafts in treating distal arterial disease.

Main Methods:

• A retrospective analysis of 28 popliteo-pedal bypass procedures in 24 patients (July 1998-November 2008).
• Exclusive use of autologous vein grafts with distal anastomosis to the plantar or dorsalis pedis arteries.
• Indications included tissue loss (n=21) and rest pain (n=7); ultrasound graft surveillance was performed every 6 months.

Main Results:

• Primary graft patency was 63.3% and secondary patency was 74.6% at 1, 3, and 5 years.
• Limb salvage rate was 81.8% at 1, 3, and 5 years, with all amputations occurring within 3 months post-surgery.
• Overall survival was 75% at 1 and 3 years, decreasing to 47.1% at 5 years. Major amputation-free survival was 54.2% at 1 and 3 years, and 21.3% at 5 years.
• Diabetes was prevalent, affecting 79% of patients.

Conclusions:

• Popliteo-pedal bypass is an effective treatment for severe distal arterial disease.
• Further randomized trials comparing bypass surgery with endovascular treatment are warranted.