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Femoral-tibial bypass for calcific arterial disease
J R Rubin1, J Persky, M C Lukens
1Department of Surgery, Cleveland Veterans Administration Medical Center, Ohio.
American Journal of Surgery
|August 1, 1989
Summary
Femoral-distal bypass surgery in patients with calcified arteries can achieve high limb salvage and graft patency rates. This study shows successful outcomes, challenging previous poor prognostic views for such cases.
Area of Science:
- Vascular Surgery
- Arterial Disease Management
Background:
- Overt calcification in recipient arteries is traditionally considered a negative prognostic indicator for femoral-distal bypass.
- Poor graft patency and wound healing are associated with arterial calcification.
Purpose of the Study:
- To evaluate short- and long-term limb salvage and graft patency rates in patients undergoing femoral-tibial bypass to calcified arteries.
- To assess the feasibility and outcomes of bypassing calcified arterial beds.
Main Methods:
- Retrospective review of 35 patients with 38 attempted femoral-tibial bypasses to calcified recipient arteries.
- Surgical techniques included in situ saphenous vein bypass, polytetrafluoroethylene (PTFE), and composite grafts.
Main Results:
- Immediate limb salvage was achieved in 86% of cases (31 of 36 limbs).
- Three-year primary graft patency and limb salvage rates were comparable to bypasses in non-calcified vessels.
- Early below-knee amputations occurred in 14% of patients.
Conclusions:
- Femoral-distal bypass can be successfully performed even in the presence of significant arterial calcification.
- This procedure offers a favorable prognosis for long-term graft patency and limb salvage in selected patients.