Pedal bypass surgery after crural endovascular intervention

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Critical Limb Ischemia

Background:

• Endovascular intervention is often the first-line treatment for crural occlusions in critical limb ischemia (Rutherford 4-6).
• Unsuccessful endovascular interventions can lead to major amputation, highlighting the need for alternative strategies.
• Pedal bypass surgery is a viable alternative first-line treatment for these patients.

Purpose of the Study:

• To evaluate the impact of prior endovascular intervention on the outcomes of pedal bypass surgery.
• To compare outcomes between patients who underwent pedal bypass after prior endovascular intervention and those who had bypass as a first-line treatment.

Main Methods:

• Retrospective analysis of 75 pedal bypass operations in 71 patients (February 2008 - October 2012).
• Patients were divided into two groups: prior endovascular intervention (PEI group, 36 cases) and bypass surgery first-line (BSF group, 39 cases).
• Endpoints included primary/secondary patency, mortality, and limb salvage at 1 year, using only autologous vein grafts.

Main Results:

• Overall 1-year primary patency was 58.3%, secondary patency 61.3%, limb salvage 76.8%, and survival 80.4%.
• The PEI group showed numerically higher primary (67.0% vs 48.3%) and secondary patency (73.5% vs 48.6%) compared to the BSF group, though not statistically significant.
• Prior endovascular intervention did not significantly impact limb salvage, graft occlusions within 30 days, or survival rates.

Conclusions:

• Crural endovascular intervention does not appear to negatively affect subsequent pedal bypass surgery outcomes.
• Avoiding target vessel destruction and timely bypass are essential when endovascular treatment is insufficient for wound healing.
• Early graft occlusions significantly increase the risk of major amputation.