Inframalleolar bypass for chronic limb-threatening ischemia

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Ischemia Management

Background:

• Chronic limb-threatening ischemia (CLTI) poses a significant risk of amputation and mortality.
• Inframalleolar bypass grafting is a critical revascularization strategy for CLTI when more proximal options are unavailable.
• Identifying factors influencing the success of inframalleolar bypass is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of inframalleolar bypass for CLTI.
• To identify predictors of success and failure in these bypass procedures.
• To analyze long-term outcomes including patency, limb salvage, and survival.

Main Methods:

• Retrospective, single-center study including 60 patients (64 limbs) with CLTI undergoing inframalleolar bypass from 2015-2018.
• Great saphenous vein was the primary conduit, often used in a devalvulated fashion.
• Analysis included primary and secondary patency, limb salvage, amputation-free survival, and overall survival rates.
• Multivariate analysis was performed to identify independent predictors of outcomes.

Main Results:

• Two-year primary patency was 67%, secondary patency 88%, limb salvage 84%, and overall survival 85%.
• Dialysis was an independent predictor of poor primary patency (HR 4.6).
• Short bypasses (originating from the popliteal artery) were associated with increased primary patency (HR 0.3).

Conclusions:

• Inframalleolar bypass grafting provides favorable patency, limb salvage, and survival rates in CLTI patients.
• While dialysis is linked to reduced primary patency, these patients still benefit from good limb salvage and survival.
• Short bypasses represent a valuable technique for enhancing graft patency in inframalleolar reconstructions.