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Simultaneous multilevel bypass grafts for extensive arterial disease offer good long-term outcomes and acceptable mortality in high-risk patients. This approach provides significant benefits for severe critical limb ischemia and tissue loss.

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Area of Science:

  • Vascular Surgery
  • Cardiovascular Medicine
  • Surgical Outcomes

Background:

  • Multilevel arterial disease traditionally treated with inflow procedures alone.
  • Simultaneous multilevel bypass grafts attempted but considered high-risk.
  • This study reports a single-center experience with multilevel bypass grafts over 15 years.

Purpose of the Study:

  • To evaluate the safety and efficacy of simultaneous multilevel bypass grafts.
  • To assess outcomes in patients with extensive aortoiliac and infrainguinal disease.
  • To determine the benefits of primary multilevel grafting in high-risk patients.

Main Methods:

  • Retrospective review of patients undergoing simultaneous aortoiliac and infrainguinal bypasses.
  • Data collected from January 1996 to January 2011 at a single district general hospital.
  • Analysis of surgical indications, reconstruction methods, mortality, morbidity, and long-term outcomes.

Main Results:

  • 32 multilevel procedures performed for acute ischemia, critical ischemia, tissue loss, or claudication.
  • High inflow reconstruction rates (71.9% direct, 28.1% extra-anatomic).
  • Low 30-day mortality (6.3%), high survival to discharge (90.6%), and 1-year survival (87.5%).
  • Excellent limb salvage rates: 96.9% at 30 days, 85.7% at 1 year, 75.9% at 5 years.
  • 12 patients (37.5%) required re-interventions.

Conclusions:

  • Multilevel bypass procedures yield good long-term outcomes and acceptable mortality in high-risk patients.
  • Significant benefits observed for primary multilevel grafting in severe critical limb ischemia with tissue loss.
  • This approach is a viable option for complex arterial disease involving multiple levels.