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Results of peripheral bypass surgery in patients with critical limb ischemia (CRITISCH registry)

T Bisdas1, G Torsello1, A Stachmann1

  • 1Klinik für Vaskuläre und Endovaskuläre Chirurgie, Universitätsklinikum and St. Franziskus Hospital Münster, Münster, Germany.

Gefasschirurgie : Zeitschrift Fur Vaskulare Und Endovaskulare Chirurgie : Organ Der Deutschen Und Der Osterreichischen Gesellschaft Fur Gefasschirurgie Unter Mitarbeit Der Schweizerischen Gesellschaft Fur Gefasschirurgie
|August 24, 2016
PubMed

Insights

For critical limb ischemia (CLI) bypasses above the knee, synthetic grafts are comparable to vein grafts. However, for more distal bypasses, vein grafts demonstrate superior amputation-free survival rates.

Area of Science:

  • Vascular Surgery
  • Reconstructive Surgery
  • Critical Limb Ischemia (CLI)

Background:

  • Critical Limb Ischemia (CLI) poses a significant risk for limb loss.
  • Lower extremity bypass surgery is a key intervention for CLI.
  • The choice of bypass material and anastomosis site impacts outcomes.

Purpose of the Study:

  • To analyze outcomes of lower extremity bypass surgery in CLI patients.
  • To compare bypass materials (vein vs. synthetic grafts) based on distal anastomosis site.
  • To evaluate amputation-free survival and perioperative complications.

Main Methods:

  • Retrospective analysis of 284 CLI patients from the CRITISCH registry.
  • Patients categorized by distal anastomosis: above knee (Group 1), below knee (Group 2), crural/pedal (Group 3).
  • Comparison of autologous saphenous vein grafts (n=159) versus synthetic grafts (n=125).

Main Results:

  • Amputation-free survival at 1 year was 86% (Group 1), 65% (Group 2), and 69% (Group 3).
  • Above-knee bypasses: synthetic grafts showed similar amputation-free survival (92%) compared to vein grafts (71%).
  • Crural/pedal bypasses: vein grafts yielded better 1-year amputation-free survival (76%) than synthetic grafts (56%).

Conclusions:

  • For above-knee bypasses in CLI patients, synthetic grafts are non-inferior to vein grafts at 1-year follow-up.
  • Vein grafts are preferable for more distal anastomoses (below knee, crural/pedal) to improve amputation-free survival.
  • Lower PREVENT III (PIII) CLI risk scores and Rutherford class correlate with better outcomes.
Abstract

Keywords:
Amputation-free survivalAutologous veinBypass surgeryCritical limb ischemiaProsthetic graft

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