[Autologous Bypass to Pedal Side Branches to Avoid a Major Amputation]

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Ischemia Research

Background:

• Critical limb ischemia (CLI) management often involves pedal vein graft bypass.
• Bypasses to pedal artery branches are sometimes necessary based on angiography.
• Autologous vein grafts are crucial for limb salvage in CLI.

Purpose of the Study:

• To evaluate the efficacy of bypass to pedal artery branches for critical limb ischemia.
• To determine the long-term limb salvage rates for this specific surgical technique.
• To assess the suitability of pedal artery branch bypass when larger arteries are compromised.

Main Methods:

• Retrospective analysis of patients undergoing bypass to pedal artery branches for CLI.
• Data collected from January 1998 to June 2014.
• Inclusion of allogeneic vein graft bypasses to various pedal artery branches and plantar bifurcations.

Main Results:

• 72 patients (out of 534 pedal bypass surgeries) received bypasses to pedal artery branches.
• Proximal anastomosis was above the knee (30) or below the knee (42).
• An 82% limb salvage rate was achieved at both 5 and 10 years post-surgery.

Conclusions:

• Bypass to pedal artery branches is a viable and effective limb salvage procedure for critical limb ischemia.
• This technique is particularly recommended when direct bypass to larger diameter arteries is not feasible.
• The study highlights the long-term success of autologous vein grafts in complex CLI cases.