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[Repeated subinguinal bypass. Report of 85 cases]
T Delaunay1, C Peillon, J L Bourgois
1Clinique Chirurgicale, Hôpital Charles Nicolle, Rouen.
Journal De Chirurgie
|November 1, 1990
Summary
Repeated subinguinal bypass (SIB) surgery offers a 47.9% limb preservation rate at 5 years, but graft patency varies by material. Venous grafts show better long-term permeability than prosthetic options for these complex cases.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Arterial Disease Management
Context:
- The study addresses the challenge of managing failing initial bypass grafts, a common issue in peripheral arterial disease treatment.
- Repeated surgical interventions, specifically subinguinal bypass (SIB), were analyzed in a cohort of patients experiencing graft thrombosis.
- Graft failure necessitates revascularization strategies, with repeated SIB being a potential, albeit complex, option.
Purpose:
- To evaluate the efficacy and outcomes of repeated subinguinal bypass (SIB) procedures in patients with thrombosed initial bypass grafts.
- To determine the long-term patency rates and limb salvage success associated with repeat SIB procedures.
- To identify predictive factors for successful outcomes in repeated SIB, guiding surgical decision-making.
Summary:
- A total of 68 patients underwent 84 repeated SIB procedures between 1975 and 1987 for acute or chronic ischemia.
- Graft materials included venous, prosthetic, and mixed types, with distal anastomoses performed at various levels (popliteal or tibial arteries).
- The 1-year actuarial permeability rate was 21.7% overall (50.2% for venous, 13.6% for prosthetic), with a 5-year limb preservation rate of 47.9% and 1% operative mortality.
Impact:
- Results suggest repeated SIB is most effective for limb salvage when the distal arterial bed is suitable and autologous venous material is available.
- The study highlights the superior patency of venous grafts in repeated SIB procedures compared to prosthetic materials.
- Understanding these outcomes can help surgeons optimize patient selection and surgical technique for complex revascularization scenarios, potentially reducing amputation rates.