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Long-Term Results of Distal Bypass for Intermittent Claudication
Taira Kobayashi1, Masaki Hamamoto1, Takanobu Okazaki1
1Department of Cardiovascular Surgery, 13754JA Hiroshima General Hospital, Hatsukaichi, Japan.
Insights
Distal bypass (DB) is effective for intermittent claudication (IC), showing superior graft patency and amputation-free survival compared to critical limb ischemia (CLI) patients. This vascular procedure maintains daily activity levels for IC patients.
Area of Science:
- Vascular Surgery
- Peripheral Artery Disease
- Limb Salvage
Background:
- Distal bypass (DB) is the gold standard for critical limb ischemia (CLI).
- The efficacy of DB for intermittent claudication (IC) is not well-established.
- This study compares long-term outcomes of DB in IC versus CLI patients.
Purpose of the Study:
- To evaluate the long-term effectiveness of distal bypass (DB) in patients with intermittent claudication (IC).
- To compare outcomes of DB for IC (IC-DB) against DB for critical limb ischemia (CLI-DB).
Main Methods:
- Retrospective review of 302 distal bypass procedures (2009-2018).
- Analysis of operative details, primary/secondary graft patency, amputation-free survival (AFS), and Barthel index.
- Comparison between 49 IC-DB cases and CLI-DB cases.
Main Results:
- IC-DB demonstrated significantly higher primary (65% vs. CLI-DB) and secondary patency (90% vs. CLI-DB) at 5 years.
- Amputation-free survival was significantly better for IC-DB (90% at 5 years) compared to CLI-DB (43%).
- Daily activity, measured by Barthel index, remained high in IC-DB patients post-procedure.
Conclusions:
- Distal bypass is a promising treatment for intermittent claudication.
- DB offers durable graft patency and acceptable amputation-free survival for IC patients.
- The procedure effectively maintains patients' daily functional capacity.
Background:
Distal bypass (DB) is the optimal treatment for patients with critical limb ischemia (CLI). However, effectiveness of DB for patients with intermittent claudication (IC) remains uncertain. This study aimed to analyze long-term results of DB for IC patients (IC-DB) compared with those of DB for CLI patients (CLI-DB).
Methods:
Patients undergoing DB from January 2009 to July 2018 at a single institution were retrospectively reviewed. Operative details, primary and secondary patency, amputation free survival rate (AFS), and long-term exercise capacity using Barthel index were analyzed.
Results:
Out of 302 DB (245 patients), 49 IC-DB were performed in 43 patients: 38 males, mean age 70.3 ± 8.0 years, diabetes mellitus 51%, chronic renal failure with hemodialysis 7%. The Great saphenous vein was used in 47 limbs, the small saphenous vein in 1, and the arm vein in 1. These grafts were bypassed in a non-reversed fashion for 35 limbs, in an in-situ fashion in 9, and in a reversed fashion in 5. The mean operative time was 173 min. The mean follow-up was 25 ± 26 months. Primary and secondary patency of IC-DB was 79% and 94% at 1 year, 71% and 90% at 3 years, 65% and 90% at 5 years, which were significantly higher than those of CLI-DB (primary patency: P = .007, secondary patency: P = .025). AFS of IC-DB and CLI-DB was 100% and 77% at 1 year, 93% and 52% at 3 years, and 90% and 43% at 5 years (IC-DB vs. CLI-DB, p < .0001). Barthel index of IC-DB unchanged at discharge (median 100) and at the last visit (median 100), showing daily activity was maintained adequately.
Conclusions:
DB could offer a promising approach for patients with IC because of durable graft patency, acceptable AFS, and maintenance of daily activity.
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