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[Autologous Bypass to Pedal Side Branches to Avoid a Major Amputation]
F Dünschede1, N Paul2, A Meyer1
1Klinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Deutschland.
Insights
Bypassing critical limb ischemia (CLI) to pedal arteries offers an 82% limb salvage rate at 5 and 10 years. This procedure is recommended when larger arteries are unavailable.
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.
Abstract:
Background: In critical limb ischaemia (CLI), a pedal vein graft bypass offers good long-term results regarding function and limb salvage. However, some cases require bypasses to branches of pedal arteries based on angiographic findings. Methods: In a retrospective database we analysed all patients who received a vein graft bypass to branches of pedal arteries for treatment of critical limb ischaemia. Results: From January 1998 to June 2014 we performed bypasses to branches of pedal arteries in 72 patients (59 men and 13 women) out of a total of 534 patients who underwent pedal bypass surgery. The proximal bypass anastomosis was above the knee in 30 cases and below the knee in 42 patients. In 6 cases the bypass connection was made to the lateral tarsal artery, in 15 cases it was made to the lateral and in 24 cases to the medial plantar artery. In 27 patients a direct connection was made to the plantar bifurcation. All reconstructions were completely autologous. The limb salvage rate after 5 and 10 years was 82 %. Conclusion: A bypass to branches of pedal arteries is a procedure recommendable for limb salvage in cases of critical ischaemia where arteries with a larger diameter are no longer available.
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