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Limb loss with patent infra-inguinal bypasses
A M Dietzek1, S K Gupta, H B Kram
1Division of Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York 10467.
European Journal of Vascular Surgery
|August 1, 1990
Summary
Despite a patent infra-inguinal bypass graft, diabetes, extensive pedal necrosis, and advanced infection increase limb loss risk. Early graft extension to distal arteries or to plantar arteries can improve limb salvage rates.
Area of Science:
- Vascular Surgery
- Limb Salvage Surgery
- Peripheral Artery Disease
Background:
- Infra-inguinal bypass grafts are crucial for limb salvage in peripheral artery disease.
- Graft patency does not always guarantee limb salvage, necessitating identification of failure factors.
Purpose of the Study:
- To identify systemic and local risk factors for limb loss despite a patent infra-inguinal bypass graft.
- To explore strategies for preventing major amputations in these high-risk patients.
Main Methods:
- Retrospective review of 987 patients undergoing infra-inguinal bypass.
- Analysis of systemic risk factors, arteriographic findings (run-off, tibial continuity), and postoperative hemodynamic improvement.
- Evaluation of foot necrosis and infection extent in patients with and without limb loss.
Main Results:
- 7.6% of patients with patent grafts underwent major amputation (below-knee or above-knee).
- Diabetes, extensive pedal necrosis, and advanced infection were significant risk factors for limb loss.
- Poorer postoperative hemodynamic improvement was noted in patients with bypass to an isolated popliteal segment who lost their limbs.
Conclusions:
- Limb loss despite a patent bypass is associated with specific patient factors and suboptimal graft targets.
- Early graft extension to reconstituted or distal tibial/peroneal arteries may reduce amputation rates.
- Distal extension to plantar arteries can salvage limbs when bypass to isolated tibial/peroneal segments fails.